Late Effects	Causative Treatment	Signs and Symptoms	Screening and Diagnostic Tests	Management and Intervention
*Adapted from Schwartz et al.[34]
Chronic otitis	Radiation: >35 Gy	Dryness and thickening of canal and tympanic membrane, conductive hearing loss, perforation of tympanic membrane	Otoscopic exam, audiometry	Antibiotic therapy, decongestants, myringotomy, pressure equalizer tubes, preferential seating in school, amplification
Sensorineural hearing loss	Chemotherapy: Cisplatin, carboplatin	High frequency hearing loss (bilateral), tinnitus, vertigo	Conventional pure tone audiogram baseline and then every 2–3 years; bilateral, symmetrical, irreversible	Preferential seating in school, amplification
	Radiation: 40–50 Gy, cranial radiation enhances the platinum effect
Decreased production of cerumen	Radiation: 30–40 Gy	Hard and encrusted cerumen in canal, hearing impairment, otitis externa	Examination of canal	Periodic cleaning of ear canal, cerumen-loosening agents, otic drops for otitis externa; keep ear dry: ear plugs, drying solution
Chondritis	Radiation: 50 Gy	Cauliflower ear	Inspection of auricle	Antibiotics, surgical repair (reconstruction may be hampered by poor blood supply)
Chondronecrosis	Radiation: 60 Gy	—	—	Antibiotics, surgical repair (reconstruction may be hampered by poor blood supply)

References

34. Schwartz C L, Hobbie WL, Constine LS, et al., eds.: Survivors of Childhood Cancer: Assessment and Management. St. Louis, Mo: Mosby, 1994.