• .Outer earMiddle earInner ear
Ability to perceive sound by detecting vibrationsthrough ear
Hearing loss???
ConductiveSensori-neuralMixed
Conductive Hearing LossAtresiaWaxOtitis externaOtitis mediaCholesteatomaOtosclerosisOssiculardiscontiunityGlomus T...
Mixed Hearing LossConductiveSensorineuralMixed
Sensorineural Hearing Loss Congenital birth defects Hereditary/genetic factors Noise trauma Head injury Ototoxicity
 Aging Measles Mumps Meningitis Meniers Tumors
uncontrollableirreversibleindependentuncoordinated autonomousunlimited abnormalover growth of tissues.
Cancer spreads…By invasion tothetissuesBy metastasis tosites
Malignant
ConductiveHearing LossSensorineuralHearing LossHearing LossResulting fromCancer
INDIRECTEFFECTSTreatmentRadiationtherapyChemo-therapy
Radiation damages sensory hair cells ofthe inner earDamage from radiation can affect one orboth the ears depending on the ...
Chemotherapy drugs used forHead & neck cancerCervical carcinomaLung cancerNeurologic cancerBreast cancerleukimiaBrain tumo...
Nitrogenmustard
Out of 32 patients(aged 30-59yrs),hearing loss wasconfirmed in 23%ofpatientsOut of 67 patients(aged 8 months to 23years), ...
Glomus Tumors• Most common benignneoplasm of the middleear.• Patients present withconductive hearing loss,pulsatile unilat...
NasopharyngealCancer Cancer that occurs in thenasopharynx, which islocated behind the noseand near the EustachianTube Co...
31
• It occurs in the nasopharynx, which is located behind thenose and above the back of the throat.• The nasopharynx is the ...
Malignant tumors of nasopharynxSquamous Cell CarcinomaLymphomaLarge Miscellaneous Group
Age40-50 years
Well known to ENTspecialist but notfamiliar to audiologist
010203040506070Symptom from NPC found in Siriraj hospital
0102030405060Symptom & sign of NPC frequency at diagnostic in Mayo clinic series KualaLumpur 1983
CausesGeneticfactorsEnvironmentalfactorsmicroelementnickel(Ni)Epsteinbarr virus
Ear involvement
A Study……Beth McLeod & GlenCroxson (2004 )Subject:52 year oldmanPresentcomplaintsa blockedfeeling in theleft ear, &tinnitu...
The case study is offered to illustrate thenecessity for audiologists to be aware thatunilateral effusions are associated ...
TreatmentFirst by radiationtherapyChemotherapy
Pathophysiology of hearing loss fromtreatment..Chemotherapy andradiationProducefree radicalsResults inototoxicitySensorine...
Free radicals•They are very reactive & unstablesubstances which cause damage to the cellwalls
How are free radicals produced??They are formed from exposure to elements inchemotherapy & radiation therapy.
How are they harmful???
Other Studies• Clinicians should inform patients of the risk of hearing loss, particularly the treatmentwith cisplatin.• H...
Present Complaints..Came on09-07-2011Reduced hearingsince 2 yearsC/O Tinnitus(continous lowfrequency)H/o ear dischargefrom...
R/O progress inhearingsensitivityNo C/o vertigoNo C/o Speechdiscrimination innoisy situationsGiddiness whilehearing loudso...
NasopharyngealTumorUnderwentMedicationfor 4 MonthsTook 33Radiation and5 Chemo-therapyFollow-up inevery 3months
Test Results
PTAImmittanceAudiometry• Bilateral ‘B’ type tympanogram withabsent reflexSpeechAudiometryEar SAT SRT SDSRight 55 dB HL 75 ...
• Bilateral moderatelysevere conductivehearing lossAudiologicalInterpretation• ENT Consultation• Re-evaluation after ENTCo...
Through telephonicconversation thepatient reported thatshe is not having theear discharge afterthe treatmentBut reported o...
• Nasopharyngeal cancer results in hearing losswhich can be conductive or sensorineuralhearing loss..• Unilateral conducti...
It is important to obtaina baselineaudiogram, prior tobeginning treatment orsoon after..Hearing should bemonitored at regu...
Researchers found that intakeof the drug NAC (N-acetylcysteine) prior tochemotherapy did not sufferfrom ototoxicity..Resea...
Audiometricprofile ofpatientundergoingcancertreatment tobedeveloped..Pre & Posttreatmentassessmentof hearingmust bedone in...
References Diseases of the ear(6th edition);Harold Ludman &Tony Wright Auditory Diagnosis(2nd edition);Ross J Roeser Jo...
• The Australian & New Zealand Journal ofaudiology, vol 26, 2, 2004, 139-141)• American Journal of Roentgenology,June 2003...
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
Nasopharyngeal carcinoma and hearing loss
of 69

Nasopharyngeal carcinoma and hearing loss

Published on: Mar 3, 2016
Published in: Health & Medicine      Business      
Source: www.slideshare.net


Transcripts - Nasopharyngeal carcinoma and hearing loss

  • 1. • .Outer earMiddle earInner ear
  • 2. Ability to perceive sound by detecting vibrationsthrough ear
  • 3. Hearing loss???
  • 4. ConductiveSensori-neuralMixed
  • 5. Conductive Hearing LossAtresiaWaxOtitis externaOtitis mediaCholesteatomaOtosclerosisOssiculardiscontiunityGlomus Tumor
  • 6. Mixed Hearing LossConductiveSensorineuralMixed
  • 7. Sensorineural Hearing Loss Congenital birth defects Hereditary/genetic factors Noise trauma Head injury Ototoxicity
  • 8.  Aging Measles Mumps Meningitis Meniers Tumors
  • 9. uncontrollableirreversibleindependentuncoordinated autonomousunlimited abnormalover growth of tissues.
  • 10. Cancer spreads…By invasion tothetissuesBy metastasis tosites
  • 11. Malignant
  • 12. ConductiveHearing LossSensorineuralHearing LossHearing LossResulting fromCancer
  • 13. INDIRECTEFFECTSTreatmentRadiationtherapyChemo-therapy
  • 14. Radiation damages sensory hair cells ofthe inner earDamage from radiation can affect one orboth the ears depending on the area ofradiationSensorineural hearing loss
  • 15. Chemotherapy drugs used forHead & neck cancerCervical carcinomaLung cancerNeurologic cancerBreast cancerleukimiaBrain tumourNeuroblastomaNasopharyngeal carcinoma
  • 16. Nitrogenmustard
  • 17. Out of 32 patients(aged 30-59yrs),hearing loss wasconfirmed in 23%ofpatientsOut of 67 patients(aged 8 months to 23years), 61%developed hearingloss following onset oftreatment[Annuals of Oncology,2002][Oregon health & science center,2005]
  • 18. Glomus Tumors• Most common benignneoplasm of the middleear.• Patients present withconductive hearing loss,pulsatile unilateraltinnitus & a middle earmass• A type tympanogram withtiny saw-tooth variationsCerebellopontine angledTumors• 80% 0f tumors areacoustic neuromas• Patients present with aprogressive, unilateral, sensorineural hearing loss• Reduced SDS scores, Rollover will bepresent,absent reflexes• ABR will demonstrate anincreased wave I to Vinterpeak latency
  • 19. NasopharyngealCancer Cancer that occurs in thenasopharynx, which islocated behind the noseand near the EustachianTube Conductive hearing lossis the most commonsymptom Sometimes leads tosensorineural hearing lossalso
  • 20. 31
  • 21. • It occurs in the nasopharynx, which is located behind thenose and above the back of the throat.• The nasopharynx is the upper portion of the pharynx — a5-inch tube that extends from behind the nose to the top ofthe windpipe and esophagus.• NPC is the most common neoplasm to causeunilateral ET obstruction.
  • 22. Malignant tumors of nasopharynxSquamous Cell CarcinomaLymphomaLarge Miscellaneous Group
  • 23. Age40-50 years
  • 24. Well known to ENTspecialist but notfamiliar to audiologist
  • 25. 010203040506070Symptom from NPC found in Siriraj hospital
  • 26. 0102030405060Symptom & sign of NPC frequency at diagnostic in Mayo clinic series KualaLumpur 1983
  • 27. CausesGeneticfactorsEnvironmentalfactorsmicroelementnickel(Ni)Epsteinbarr virus
  • 28. Ear involvement
  • 29. A Study……Beth McLeod & GlenCroxson (2004 )Subject:52 year oldmanPresentcomplaintsa blockedfeeling in theleft ear, &tinnitusTest resultsPTA :Rt ear-normalLt ear-38 dBLt ear:-Flattympanogramwith absentreflexesRt ear:- normalDiagnosed as mild tomoderate conductiveHL for the left earOn further evaluationthe case wasdiagnosed as NPCPost treatmentassessmentBoth PTA &tympanometryindicatedsymmetricalnormal hearing
  • 30. The case study is offered to illustrate thenecessity for audiologists to be aware thatunilateral effusions are associated with NPC
  • 31. TreatmentFirst by radiationtherapyChemotherapy
  • 32. Pathophysiology of hearing loss fromtreatment..Chemotherapy andradiationProducefree radicalsResults inototoxicitySensorineuralhearing loss
  • 33. Free radicals•They are very reactive & unstablesubstances which cause damage to the cellwalls
  • 34. How are free radicals produced??They are formed from exposure to elements inchemotherapy & radiation therapy.
  • 35. How are they harmful???
  • 36. Other Studies• Clinicians should inform patients of the risk of hearing loss, particularly the treatmentwith cisplatin.• Hearing test should be a routine test after chemotherapy.Yupa &Vasana,2007• The pre- and post-therapeutic hearing levels were recorded in a previously publishedstudy of 20 patients receiving radiotherapy for NPC• The incidence of SNHL increased significantly with increasing dose of radiation.Ling, Wen-Rei Kuo, Kuen-Yao Ho, Ka-Wo Lee,2003• After RT, at least a 10 dB loss in bone conduction threshold at speech frequency• effect of radiation on hearing tended to be chronic and progressive.Henriette B. Honore, Soren M. Bentzenb, Kitty Mollerc, Cai Graud,2002• BC Thresholds at 0.5,1,2,4 kHz kHz were compared with pretreatment thresholds atrespective frequencies.• SNHL occurred after radiotherapy, more commonly affecting high frequency.KWONG,WEI&YUEN,1996
  • 37. Present Complaints..Came on09-07-2011Reduced hearingsince 2 yearsC/O Tinnitus(continous lowfrequency)H/o ear dischargefrom both ears forthe past 6 monthsCase name: XAge/sex: 42yrs/F
  • 38. R/O progress inhearingsensitivityNo C/o vertigoNo C/o Speechdiscrimination innoisy situationsGiddiness whilehearing loudsounds
  • 39. NasopharyngealTumorUnderwentMedicationfor 4 MonthsTook 33Radiation and5 Chemo-therapyFollow-up inevery 3months
  • 40. Test Results
  • 41. PTAImmittanceAudiometry• Bilateral ‘B’ type tympanogram withabsent reflexSpeechAudiometryEar SAT SRT SDSRight 55 dB HL 75 dB HL 90%Left 55 dB HL 70 dB HL 100%
  • 42. • Bilateral moderatelysevere conductivehearing lossAudiologicalInterpretation• ENT Consultation• Re-evaluation after ENTConsultation• Follow UpRecommendations
  • 43. Through telephonicconversation thepatient reported thatshe is not having theear discharge afterthe treatmentBut reported ofhaving difficulty inhearing andtinnitus in bothear
  • 44. • Nasopharyngeal cancer results in hearing losswhich can be conductive or sensorineuralhearing loss..• Unilateral conductive hearing loss with a flattympanogram indicates a middle ear effusionwhich can be one of the symptom of NPC..
  • 45. It is important to obtaina baselineaudiogram, prior tobeginning treatment orsoon after..Hearing should bemonitored at regularintervals duringtreatment..
  • 46. Researchers found that intakeof the drug NAC (N-acetylcysteine) prior tochemotherapy did not sufferfrom ototoxicity..Research is going on aboutProton beam therapy whichhelps in reduced ototoxicity..
  • 47. Audiometricprofile ofpatientundergoingcancertreatment tobedeveloped..Pre & Posttreatmentassessmentof hearingmust bedone inclinicalpractice forfutureresearch..
  • 48. References Diseases of the ear(6th edition);Harold Ludman &Tony Wright Auditory Diagnosis(2nd edition);Ross J Roeser Journal of Medical Association,Thai 2010; 93 (3):324-9 Journal of Radiotherapy and Oncology 65 (2002) 9–16
  • 49. • The Australian & New Zealand Journal ofaudiology, vol 26, 2, 2004, 139-141)• American Journal of Roentgenology,June 2003 vol.180• Journal of Clinical Oncology,1998; 16: 1310–1317.• Journal of Clinical Oncology,2001; 19: 1105–1110.

Related Documents