Brain Tumor Therapy Tied to Severe Sensorineural Hearing Loss, Difficulty Reading

Over time, young patients with severe sensorineural hearing loss (SNHL) face difficulty with reading, and struggle most with phonological skills and processing speed, a recent study shows (J Clin Oncol. 2019 May 2. Epub ahead of print).

“[SNHL] is associated with intellectual and academic declines in children treated for embryonal brain tumors,” said Traci W. Olivier, PsyD, St. Jude Children’s Research Hospital, Memphis, Tennessee, and colleagues.

“This study expands upon existing research by examining core neurocognitive processes that may result in reading difficulties in children with treatment-related ototoxicity,” they added.

Using linear mixed models, the investigators analyzed prospectively collected, serial, neuropsychological, and audiology data for 260 children and young adults aged 3 to 21 years enrolled in a multi-center research and treatment protocol, which included surgery, risk-adapted craniospinal irradiation (average risk, n = 186; high-risk, n = 74), and chemotherapy.

Dr Olivier and colleagues evaluated patients at baseline and up to 5 years postdiagnosis; they were grouped according to degree of SNHL. A total of 196 children with intact hearing or mild to moderate SNHL (Chang grade 0, 1a, 1b, or 2a) were also included in the study, as were 64 children with severe SNHL (Chang grade ≥2b).

The researchers analyzed performance on 8 neurocognitive variables targeting reading outcomes (eg, phonemics, fluency, comprehension) and contributory cognitive processes (eg, working memory, processing speed).

Ultimately, findings showed that children with severe SNHL had greater reading difficulties over time than those without severe SNHL. In particular, they struggle most with phonological skills and processing speed, which in turn affects higher level skills (eg, reading comprehension).

Patients with severe SNHL performed significantly worse than children with normal or mild to moderate SNHL on all variables (P ≤.05), aside from tasks evaluating awareness of sounds and working memory.

In addition, when controlled for age at diagnosis and risk-adapted craniospinal irradiation dose, children with severe SNHL had significantly lower performance on phonemic skills, phonetic decoding, reading comprehension, and speed of information processing (P ≤.05) than their counterparts.

“This study documents important findings regarding specific language-based neurocognitive outcomes that are affected in children with acquired SNHL secondary to ototoxicity,” Dr Olivier and colleagues concluded.

“Future research determining which interventions (and at what time in treatment) are most efficacious in bolstering reading skills in children undergoing cancer-directed treatment is crucial and may have important implications for others with SNHL,” they said.—Hina Khaliq

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