使用耳毒性藥物病童應列入常規聽力監控：接受鉑類化療藥物治療肝母細胞瘤病童之個案報告

Establishing a Systematic Monitoring of Hearing Is Necessary for Child Treated With Ototoxicity Drugs: A Case Report of Hepatoblastoma Received Platinum-Based Chemotherapy

黃上維(Shang-Wei Huang) ； 陳湘湘(Xiang-Xiang Chen)

《台灣聽力語言學會雜誌》 45期 (2021/12) Pp. 99-108

https://doi.org/10.6143/JSLHAT.202112_(45).0006

摘要

本個案報告為一4歲幼童因肝母細胞瘤進行化療，使用大量耳毒性藥物造成聽力下降之情況。個案在化療療程上使用卡鉑、順鉑及長春新鹼分別累積8,906、90及26 mg/m^2，過程中雖有幾次察覺其語言遲緩及聽力問題，但因照護者警覺性不足、個案早期的聽覺經驗、幼童缺乏自覺與表達能力、個案之病情或其他不可抗因素等，並因台灣臨床上尚未有常規執行之耳毒性聽力監控系統或臨床準則，而延後了個案早期發現及早期介入的黃金時機。個案4歲1個月回診時，配戴助聽器下的優耳最小反應位階為60～75分貝。因此，本文除了揭示個案使用藥物之耳毒性風險外，也提出國外機構針對耳毒性聽力監控之建議，期盼未來台灣針對使用具耳毒性之療法的病童建立嚴謹聽力學介入程序。

關鍵字

耳毒性 ； 鉑類化療 ； 聽力損失 ； 幼童

並列摘要

This reported case is a 4-year-old girl with hearing impairment following chemotherapy for hepatoblastoma. Cumulative dose of carboplatin, cisplatin, and vincristine were 8,906, 90, and 26 mg/m^2 respectively. Even though she was noticed of language delay and hearing loss during her treatment, the prime time for early detection and intervention had been delayed due to many factors, such as lack of the alertness of caregivers, child's early hearing-experience, the lack of consciousness and expression ability of the young children, the condition of illness, and also because there is no routinely implemented ototoxicity-monitoring system or guidelines in clinical placement in Taiwan. Case's minimum response level at frequency of 500, 1000, and 2000 Hz obtained from visual reinforcement audiometry were 60 to 75 dB hearing level (HL) under hearing aid at the age of four. Therefore, this report will discuss the risk on hearing loss of ototoxicity drugs this case used. And we also propose some recommendations from international institutions, hoping that the ototoxicity monitoring of young children in Taiwan will be more rigorous in the future.

並列關鍵字

Ototoxicity ； Platinum-based chemotherapy ； Hearing loss ； Child

參考文獻

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