Figure 8 Flowchart demonstrating how comprehensive ototoxicity monitoring

Figure 8. Flowchart demonstrating how comprehensive ototoxicity monitoring program for Department of Veterans Affairs (COMP-VA) monitoring protocol is used for detecting hearing and outer hair cell function changes. Pretreatment tests include otoscopy, tympanometry, distortion-product otoacoustic emission (DPOAE) testing, and air-conduction testing in conventional and extended high frequencies, and sensitive range for ototoxicity (SRO) is determined for subsequent testing. From these tests, pretreatment risk calculation is done for educational and patient counseling purposes and may prove helpful when planning professional resources. Screenings minimally include SRO audiogram for responsive/reliable patients and DPOAE level plotted as a function of f 2 frequency to detect early ototoxic changes. From DPOAE level plotted as a function of f 2 frequency, DPOAE level changes are calculated relative to baseline measures and compared with our reference limits to determine whether changes are greater than those attributable to normal test-retest variability and DPOAE input-output functions (obtained from multiple levels) are reserved for patients who are too sick to provide reliable hearing test. Any screen failure requires follow-up testing, ideally done using behavioral hearing test. Konrad-Martin D, Reavis KM, Mc. Millan G, Helt WJ, Dille M. Proposed comprehensive ototoxicity monitoring program for VA healthcare (COMP-VA). J Rehabil Res Dev. 2014; 51(1): 81– 100. http: //dx. doi. org/10. 1682/JRRD. 2013. 04. 0092