Cochlear Radiation Dose and Early Hearing Changes After Chemoradiotherapy for Head and Neck Cancer: A Single-Center Retrospective Cohort Study

Background/Objectives: Hearing impairment is a frequent but under-recognized sequela of (chemo)radiotherapy for head and neck cancer (HNC). We assessed the frequency of early post-treatment hearing changes and their association with cochlear radiation exposure and concurrent platinum-based chemotherapy.

Methods

We conducted a single-center retrospective cohort study of 70 consecutive patients with HNC treated with radiotherapy between November 2024 and September 2025. Patients receiving concurrent chemoradiotherapy (CRT, n = 48) were compared with patients receiving radiotherapy alone (RT, n = 22). The primary outcome was clinically documented post-treatment hearing change. Cochlear maximum point doses (Dmax) were extracted from treatment plans. Analyses included Fisher exact and Mann–Whitney U tests, Spearman correlations, Firth penalized logistic regression, a Cochran–Armitage trend test, and restricted cubic splines.