The use of otoacoustic emissions to predict ototoxic-induced hearing changes

Ototoxic medications put millions of U.S. patients at risk for hearing loss each year, with older adults especially vulnerable due to preexisting impairment. Although high‑frequency pure‑tone audiometry is the gold standard for monitoring ototoxicity, it requires reliable behavioral responses that many patients cannot provide. Distortion‑product otoacoustic emissions (DPOAEs), which reflect outer hair cell function, may offer an objective alternative, yet standardized protocols and clear accuracy estimates are lacking. This prospective observational study evaluated the sensitivity and specificity of DPOAEs in detecting ototoxic hearing shifts by comparing DPOAE‑derived metrics with repeated high‑frequency audiometry in cisplatin‑treated patients. A discriminant model incorporating baseline hearing, drug dose, and DPOAE measures accurately predicted significant hearing change. These findings support the development of DPOAE‑based monitoring strategies to improve early detection of ototoxicity and reduce associated communication difficulties.