a n=32 female patients a n=32 female patients range, but speech frequencies can also be affected (Schell et al. 1989; Parsons et al. 1998). It is usually irreversible, but some patients experience partial recovery (Skinner et al. 1990). Risk factors for cisplatin-induced hearing loss include cumulative dose higher than 360 mg/m2, young age at treatment, previous or concomitant cranial or head and neck irradiation, abnormal renal function, and use of other ototoxic drugs (e.g., aminoglycosides, loop diuretics) (Schell et al. 1989; Weatherly et al. 1991; Parsons et al. 1998). Hearing loss at a young age has a significant impact on the acquisition of speech and contributes to a lessened quality of life in survivors of advanced neuro-blastoma (Barr et al. 2000). Early audiological interventions, such as hearing aids and speech and language therapy, are therefore mandatory to minimize the impact of the hearing loss. The use of chemopro-tective agents, such as amifostine for platinum-induced ototoxicity, warrants further investigation (Cronin et al. 2000; Fulda et al. 2001).

In our cohort, 55% (36 of 65) of survivors have hearing loss: 10 patients (16% of the cohort) experi ence losses at high frequencies (500-2000 Hz) and 26 patients (40% of the cohort) at speech frequencies (500-2000 Hz). These results are in accordance with other studies showing that young age at treatment and high doses of platinum compounds are major risk factors for the development of hearing loss.

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