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Comparison of Automated Hearing Testing Approaches for Outpatients Receiving Ototoxic Chemotherapy

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Comparison of Automated Hearing Testing Approaches for Outpatients Receiving Ototoxic Chemotherapy University of Northern Colorado Scholarship & Creative Works @ Digital UNC Capstones & Scholarly Projects Student Research 5-2019 Comparison of Automated Hearing Testing Approaches for Outpatients Receiving Ototoxic Chemotherapy Ashley Stumpf Follow this and additional works at: https://digscholarship.unco.edu/capstones Recommended Citation Stumpf, Ashley, "Comparison of Automated Hearing Testing Approaches for Outpatients Receiving Ototoxic Chemotherapy" (2019). Capstones & Scholarly Projects. 50. https://digscholarship.unco.edu/capstones/50 This Text is brought to you for free and open access by the Student Research at Scholarship & Creative Works @ Digital UNC. It has been accepted for inclusion in Capstones & Scholarly Projects by an authorized administrator of Scholarship & Creative Works @ Digital UNC. For more information, please contact [email protected]. © 2019 ASHLEY STUMPF ALL RIGHTS RESERVED UNIVERSITY OF NORTHERN COLORADO Greeley, Colorado The Graduate School COMPARISON OF AUTOMATED HEARING TESTING APPROACHES FOR OUTPATIENTS RECEIVING OTOTOXIC CHEMOTHERAPY A Capstone Research Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Audiology Ashley Stumpf College of Natural and Health Sciences School of Audiology & Speech-Language Sciences Audiology May 2019 This Capstone Project by: Ashley Stumpf Entitled: Comparison of Automated Hearing Testing Approaches for Outpatients Receiving Ototoxic Chemotherapy has been approved as meeting the requirement for the Degree of Doctor of Audiology in the College of Natural and Health Sciences in the Department of Audiology and Speech- Language Sciences, Program of Audiology Accepted by the Capstone Research Committee ______________________________________________________ Deanna K. Meinke, Ph.D., Research Advisor ______________________________________________________ Jennifer E. Weber, Au.D., Committee Member ______________________________________________________ Kathryn Bright, Ph.D., Committee Member Accepted by the Graduate School __________________________________________________________ Linda L. Black, Ed.D. Associate Provost and Dean Graduate School and International Admissions Research and Sponsored Programs ABSTRACT Stumpf, Ashley. Comparison of Automated Hearing Testing Approaches for Outpatients Receiving Ototoxic Chemotherapy. Unpublished Doctor of Audiology Capstone Research Project, University of Northern Colorado, 2019. Detection of the highest audible frequency of hearing is used to monitor patients undergoing chemotherapy for ototoxic effects of pharmaceuticals. The current study evaluated the feasibility of utilizing Creare’s (2016) wireless attenuated hearing test system (WAHTS) in two outpatient cancer treatment centers to administer automated hearing tests for the identification of the highest audible frequency. Twenty cancer patients being treated with carboplatin and cisplatin were recruited for hearing testing and eight untrained nurses were recruited to operate the WAHTS. Ambient noise measurements were taken in each treatment center before and after hearing testing and supported the validity of threshold measurements. Listener participants completed two automated hearing tests: conventional high-frequency audiometry typically used to identify the sensitive region for ototoxicity (SRO) and a newly proposed fixed-level frequency test (FLFT; Fausti et al., 1999; Rieke et al., 2017). The highest audible frequency (HAF) identified by each test method was compared using a 2-tailed Wilcoxon signed ranks test. The HAF identified by each hearing test method (automated high frequency audiometry [AHFA] vs. FLFT) was not significantly different from each other. The FLFT was completed much faster (24.78 minutes for the AHFA versus 2.4 minutes for the FLFT). Administering the FLFT during outpatient cancer treatment therapy iii appeared to be a promising test method to potentially overcome current barriers in ototoxicity monitoring. Future research should implement the WAHTS (Creare, 2016) technology in a more diverse assortment of chemotherapy treatment centers with a larger population of participants. Use of the FLFT and AHFA would need to be evaluated as part of a clinical research study that would implement a full ototoxicity monitoring program. iv ACKNOWLEDGMENTS I wish to express my sincere gratitude to my research advisors for their continuous support throughout the process of my research. With their help, I have grown as a scholar and have a newfound respect for research and its importance in all professions. This project would not have been possible without the help from the research staff at the outpatient cancer centers. Their involvement in the completion of data collection was vital. I have the deepest appreciation for all the work they put in on my project and so many others in order to advance science. I would also like to sincerely thank my family for their unending support throughout my educational pursuits. Without their extra encouragement to go outside my comfort zone, I would not have been able to take on such an in-depth project. v TABLE OF CONTENTS CHAPTER I. STATEMENT OF THE PROBLEM ...................................................... 1 CHAPTER II. REVIEW OF THE LITERATURE........................................................ 5 Introduction ........................................................................................................ 5 Auditory System Overview................................................................................ 6 Ototoxicity ......................................................................................................... 9 Chemotherapeutics ........................................................................................... 11 Position Statements on Ototoxicity .................................................................. 16 Ototoxicity Monitoring .................................................................................... 17 Challenges in Ototoxicity ................................................................................ 19 Hearing Testing ................................................................................................ 21 Recent Advances in Ototoxicity Monitoring ................................................... 30 The Value of Ototoxic Monitoring .................................................................. 33 Rationale for Study .......................................................................................... 36 CHAPTER III. METHODS ......................................................................................... 37 Participants ....................................................................................................... 37 Instrumentation ................................................................................................ 38 Data Analysis ................................................................................................... 41 CHAPTER IV. RESULTS ........................................................................................... 43 Test Environments ........................................................................................... 43 Participants ....................................................................................................... 45 Ambient Noise Levels...................................................................................... 47 Outcomes for Highest Audible Frequency ...................................................... 54 Survey Outcomes ............................................................................................. 63 Summary of Outcomes .................................................................................... 67 CHAPTER V. DISCUSSION ...................................................................................... 69 Ambient Noise ................................................................................................. 69 Technology Implementation ............................................................................ 71 Chemotherapy Patient Factors ......................................................................... 72 Implementing Fixed-Level Frequency Test and Automated High Frequency Audiometry in Ototoxicity Monitoring .............................. 74 Potential to Increase Patient Access to Ototoxicity Monitoring ...................... 76 Strengths and Limitations ................................................................................ 77 vi Future Research ............................................................................................... 78 Conclusions ...................................................................................................... 79 REFERENCES ............................................................................................................ 80 APPENDIX A. INSTITUTIONAL REVIEW BOARD APPROVAL ........................ 94 APPENDIX B. WIRELESS HEADSET SYSTEM SURVEY FOR OPERATORS .... 97 APPENDIX C. WIRELESS HEADSET SYSTEM SURVEY FOR LISTENERS ... 101 APPENDIX D. RECIPROCAL AGREEMENT ....................................................... 105 vii LIST OF TABLES 1. Maximum Permissible Ambient Sound Levels in Decibels Sound Pressure Level .................................................................................................. 22 2. Extrapolated Mean Ambient Noise Levels in Decibels Sound Pressure Level Reported from Veterans’ Administration Hospital Ward Measurements .................................................................................................
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