儿童期顺铂治疗后双侧高频感音神经性听力损失的延迟发现：一例病例报告

文献信息

中文摘要

顺铂是儿科肿瘤学中广泛使用的化疗药物；然而，其显著的耳毒性已为人熟知。虽然听力损伤通常在治疗期间或治疗后不久出现，但迟发性或既往未发现的听觉功能障碍有时可能在数年后才显现。本报告病例涉及一名11岁男孩，既往因肝母细胞瘤接受过以顺铂为基础的化疗，在完成治疗9年后首次被发现患有双侧感音神经性听力损失。纯音测听显示双侧高频阈值升高，无气骨导差，畸变产物耳声发射（DPOAE）在高频处缺失。听性脑干反应（ABR）显示4 kHz阈值升高，神经影像学显示耳蜗或听神经无结构异常。扩展基因检测未发现与遗传性听力损失相关的致病性变异。尽管确切病因无法明确确定，但听力学模式和治疗史提示顺铂可能导致了听力损失。本病例强调了对儿童癌症幸存者进行长期听力监测的必要性，因为迟发性或既往未发现的听力缺陷可能在治疗多年后才出现临床症状。

英文摘要

Cisplatin is a widely used chemotherapeutic agent in pediatric oncology; however, it is well known for its marked ototoxicity. While hearing impairment typically emerges during or soon after therapy, progressive or previously undetected auditory dysfunction may occasionally present years later. The reported case involves an 11-year-old boy who previously received cisplatin-based chemotherapy for hepatoblastoma and was first identified as having bilateral sensorineural hearing loss 9 years after completion of treatment. Pure-tone audiometry revealed bilateral elevation of high-frequency thresholds without an air-bone gap, and distortion product otoacoustic emissions (DPOAE) were absent at high frequencies. Auditory brainstem responses (ABRs) demonstrated elevated thresholds at 4 kHz, and neuroimaging showed no structural abnormalities of the cochlea or auditory nerve. Expanded genetic testing revealed no pathogenic variants associated with hereditary hearing loss. Although the exact etiology could not be definitively established, the audiologic pattern and treatment history suggested that cisplatin may have contributed to the hearing loss. This case highlights the need for long-term hearing surveillance in childhood cancer survivors, as progressive or previously undetected deficits may not become clinically apparent until many years after treatment.