Elevated LDL Is Associated with an Increased Incidence of Cisplatin-related Ototoxicity

Introduction: While prior research has found an association between hypercholesterolemia and self-reported hearing loss in patients receiving cisplatin, this association has yet to be confirmed using objective audiologic assessments. We aimed to determine whether elevated LDL is a risk factor for cisplatin-induced ototoxicity.

Methods: A combined prospective and retrospective cohort of adults treated with cisplatin at our tertiary care center had a baseline lipid panel, a baseline audiogram, and an audiogram at least 1 month following the last chemotherapy dose. Participants with elevated baseline LDL (>100 mg/dL) or current statin usage were combined to capture overall dyslipidemia burden; this group’s audiometric results were compared with participants with normal baseline LDL and no statin usage. The primary outcome measure was ototoxicity defined by the TUNE scale. Secondary outcome measures included hearing loss incidence defined by 1) Common Terminology Criteria for Adverse Events (CTCAEv5), 2) American Speech-Language-Hearing Association (ASHA) criteria, and 3) pure tone averages. Potential confounding factors were recorded such as demographics, chemotherapy dosage, timing between audiograms, prior noise exposure, radiotherapy levels, and renal function. Significance was set at p< 0.05.

Results: From 57,021 patients with lipid panels (2017 to 2025) and 56 prospectively enrolled participants (2020 to 2023), 154 met the inclusion criteria (mean age= 57.8 years, M/F ratio = 105/49). The elevated LDL/statin group (n=120) had 2.02-fold increased risk of hearing loss on TUNE scale (95% CI 1.03 to 4.90; p=0.04) compared to the normal LDL/no statin group (n=34). No other recorded covariates were significantly associated with the outcome.

Conclusions: Elevated LDL is associated with an increased incidence of hearing loss in patients receiving cisplatin. Further research is warranted to confirm this association.