Grant: Operating Grant

Recent advances in cancer treatment are leading to rapidly increasing survival rates. The current five-year survival rate for children with cancer is 80%. Cisplatin and carboplatin are two of the most successful and widely-used anticancer drugs; however, they lead to ototoxicity in the majority of the children. Ototoxicity manifests as a permanent severe hearing loss and ringing in the ears. This can have devastating consequences on communication, school performance, social interaction, and overall quality of life. There is currently no treatment or prevention for ototoxicity, but the steroid Dexamethasone is a promising candidate. In a previously funded CIHR grant, our group has discovered intratympanic dexamethasone injection to prevent hearing loss from ototoxicity in the guinea pig. This finding has been confirmed by other groups in 5 other animal studies. Intratympanic dexamethasone is also widely used clinically to treat sudden hearing loss, and other auto-immune ear disorders. The safety and efficacy of this treatment has been well-established in numerous clinical studies for the above-mentioned disorders. While our group has started the first hearing protection clinical trial in Canada using the anti-oxidant Ringer's lactate in adult patients, there are currently no pediatric trials and no publications on intratympanic (IT) dexamethasone for platinum-induced ototoxicity. The purpose of this pilot study is to estimate the protective effect of IT dexamethasone that may be worth confirming in a subsequent larger study and to evaluate the safety and feasibility of methods for later use in a large-scale study across Canada. This pilot study will be conducted at 4 major paediatric oncology sites in 2 provinces, and will lay the ground for a larger, pan-Canadian trial involving our established network of 13 paediatric oncology centers, all of whom see the urgency and necessity for such a trial.