Proposed comprehensive ototoxicity monitoring program for VA healthcare (COMP-VA).
Prevention and rehabilitation of hearing loss and tinnitus, the two most commonly awarded service-connected disabilities, are high priority initiatives in the Department of Veterans Affairs (VA). At least 4,000 Veterans, most with significant hearing loss, will receive cisplatin this year, with more than half sustaining permanent hearing shift and nearly 40% developing new tinnitus. With improved survivability following cancer treatment, Veterans treated with cisplatin are approached with the dual goals of effective treatment and preserved quality of life. This article describes COMP-VA, a comprehensive ototoxicity monitoring program developed for VA patients receiving cisplatin. The program includes an individualized pretreatment prediction model that identifies the likelihood of hearing shift given cisplatin dose and patient factors. It supports both manual and automated hearing testing with a newly developed portable audiometer capable of performing the recommended procedures on the chemotherapy unit during treatment. It also includes objective methods for identifying outer hair cell changes and predicting audiogram changes using distortion-product otoacoustic emissions. We describe this program of evidence-based ototoxicity monitoring protocols using a case example to give the reader an understanding of how this program would be applied, along with a plan for future work to accomplish the final stages of program development.
['Konrad-Martin|Dawn|D|', 'Reavis|Kelly M|KM|', 'McMillan|Garnett|G|', 'Helt|Wendy J|WJ|', 'Dille|Marilyn|M|']
D019540:Area Under Curve D001301:Audiometry, Pure-Tone D001309:Auditory Threshold D002294:Carcinoma, Squamous Cell D002945:Cisplatin D019317:Evidence-Based Medicine D034381:Hearing Loss D006320:Hearing Tests D006801:Humans D008297:Male D008875:Middle Aged D018670:Monitoring, Ambulatory D017084:Otoacoustic Emissions, Spontaneous D016730:Program Development D011788:Quality of Life D012372:ROC Curve D018570:Risk Assessment D014012:Tinnitus D014062:Tongue Neoplasms D014067:Tonsillar Neoplasms D014481:United States D014728:Veterans
ototoxicity monitoring COMP-VA hearing cisplatin chemotherapy distortion-product otoacoustic emissions DPOAE OtoID aural rehabilitation sensitive range for 
ototoxicity