Scholarlink

Objective <p>To evaluate the efficacy of the otoprotective transtympanic application of N-acetylcysteine in preventing chemotherapy-induced ototoxicity in patients subjected to platinum-based chemotherapy.</p> Data sources <p>PubMed, Scopus, Web of Science, Cochrane Central, and ClinicalTrials.gov were searched for the following concepts: ((“Acetylcysteine” [Mesh]) AND (“Ototoxicity” [Mesh]) AND (“Cisplatin” [Objective: To evaluate the efficacy of otoprotective transtympanic application of N-acetylcysteine in the prevention of chemotherapy-induced ototoxicity in patients subjected to platinum-based chemotherapy. [Mesh]).</p> Study selection <p>Inclusion: randomized controlled trials, Exclusion: (1) case reports or case series; (2) thesis; (3) review articles; (4) conference abstracts; (5) animal studies; (6) non-english studies; (7) studies whose population was other than patients on platinum-based chemotherapy. Data extraction: changes in hearing thresholds measured by pure tone tympanometry, covering high and low frequencies: 250, 500, 1000, 2000, 4000, and 8000&#xa0;Hz. We used RevMan (Review Manager) version 5.3 to conduct the meta-analysis and GRADE to assess the quality of the evidence. Data synthesis: The literature search yielded 277 unique articles. After reviewing six full-text articles, three RCTs provided data available for meta-analysis. A total of 88 cisplatin-based chemotherapy candidates were included for final analysis. Hearing thresholds showed a significant threshold difference between the ear treated with N-acetylcysteine and the control ear (ear not treated with N-acetylcysteine), especially at high frequencies as high as 8000&#xa0;Hz (pooled effect size − 10.67, 95% CI [-12.33, -9.02], <i>P</i> &lt; 0.00001). The data favored the Nac group in all frequencies as well, at 4000&#xa0;Hz (pooled effect size − 2.13, 95% CI [-3.49, -0.77], <i>P</i> = 0.002), at 2000&#xa0;Hz (pooled effect size − 1.38, 95% CI [-2.69, -0.06], <i>P</i> = 0.04), at 1000&#xa0;Hz (pooled effect size − 1.58, 95% CI [-2.63, -0.53], <i>P</i> = 0.003), at 500&#xa0;Hz (pooled effect size − 1.58, 95% CI [-2.62, -0.54], <i>P</i> = 0.003), and at the low frequency of 250 after solving the heterogeneity (pooled effect size − 0.96, 95% CI [-2.88, 0.95], <i>P</i> = 0.32).</p> Conclusions <p>Current data justifies the transtympanic administration of N-acetylcysteine for otoprotection in chemotherapy patients, minimizing the enduring consequences of cisplatin-induced ototoxicity and auditory impairment. Given the results’ emphasis on the Sarafraz et al. (2018) study, more randomized controlled trials are necessary with an expanded sample size and standardization of N-acetylcysteine concentration, study population, and assessed outcomes.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Intratympanic N-acetylcysteine in the prevention of cisplatin-induced ototoxicity: a systematic review and meta-analysis of randomized controlled trials

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年2月4日

查看全文
  • Mohamed Tawalbeh,
  • Rewan M. Ibrahim,
  • Taif Al-Saraireh,
  • Lubna Khreesha,
  • Baeth Al Rawashdeh

摘要

Objective

To evaluate the efficacy of the otoprotective transtympanic application of N-acetylcysteine in preventing chemotherapy-induced ototoxicity in patients subjected to platinum-based chemotherapy.

Data sources

PubMed, Scopus, Web of Science, Cochrane Central, and ClinicalTrials.gov were searched for the following concepts: ((“Acetylcysteine” [Mesh]) AND (“Ototoxicity” [Mesh]) AND (“Cisplatin” [Objective: To evaluate the efficacy of otoprotective transtympanic application of N-acetylcysteine in the prevention of chemotherapy-induced ototoxicity in patients subjected to platinum-based chemotherapy. [Mesh]).

Study selection

Inclusion: randomized controlled trials, Exclusion: (1) case reports or case series; (2) thesis; (3) review articles; (4) conference abstracts; (5) animal studies; (6) non-english studies; (7) studies whose population was other than patients on platinum-based chemotherapy. Data extraction: changes in hearing thresholds measured by pure tone tympanometry, covering high and low frequencies: 250, 500, 1000, 2000, 4000, and 8000 Hz. We used RevMan (Review Manager) version 5.3 to conduct the meta-analysis and GRADE to assess the quality of the evidence. Data synthesis: The literature search yielded 277 unique articles. After reviewing six full-text articles, three RCTs provided data available for meta-analysis. A total of 88 cisplatin-based chemotherapy candidates were included for final analysis. Hearing thresholds showed a significant threshold difference between the ear treated with N-acetylcysteine and the control ear (ear not treated with N-acetylcysteine), especially at high frequencies as high as 8000 Hz (pooled effect size − 10.67, 95% CI [-12.33, -9.02], P < 0.00001). The data favored the Nac group in all frequencies as well, at 4000 Hz (pooled effect size − 2.13, 95% CI [-3.49, -0.77], P = 0.002), at 2000 Hz (pooled effect size − 1.38, 95% CI [-2.69, -0.06], P = 0.04), at 1000 Hz (pooled effect size − 1.58, 95% CI [-2.63, -0.53], P = 0.003), at 500 Hz (pooled effect size − 1.58, 95% CI [-2.62, -0.54], P = 0.003), and at the low frequency of 250 after solving the heterogeneity (pooled effect size − 0.96, 95% CI [-2.88, 0.95], P = 0.32).

Conclusions

Current data justifies the transtympanic administration of N-acetylcysteine for otoprotection in chemotherapy patients, minimizing the enduring consequences of cisplatin-induced ototoxicity and auditory impairment. Given the results’ emphasis on the Sarafraz et al. (2018) study, more randomized controlled trials are necessary with an expanded sample size and standardization of N-acetylcysteine concentration, study population, and assessed outcomes.