Do you necessarily need an ototoxicity-specific audiogram to detect teprotumumab-associated hearing loss?

Dr Alyono: The big picture answer is we do not know yet. The audiograms that test for ototoxicity were shaped by aminoglycoside antibiotics and platinum chemotherapeutics, in which they measure hearing loss that initially affects the highest frequencies. These involve ultra high-frequency audiometry. With teprotumumab, we have seen a typical audiogram be able to pick up hearing loss, but it is not yet known whether ultra high-frequency testing might be more sensitive to early changes. We still have more to learn here, but having any kind of audiogram is better than not having an audiogram.

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