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Cis-platinum is an ototoxic antineoplastic drug. Evaluation of auditory thresholds in 33 children receiving cis-platinum shows that a threshold shift at 6 and 8 kHz is first measurable after a cumulative dose of 201 to 300 mg/m2. A 35- to 40-dB high-frequency threshold shift is evident after a cumulative cis-platinum dose of 301 to 400 mg/m2. Increasing cumulative doses of cis-platinum are associated with a greater degree of hearing loss. Receiver-operator characteristic curves were used to find a criterion value that effectively identified threshold shifts that were due to cis-platinum ototoxicity. A 15-dB or greater shift in the 6- and 8-kHz threshold average identifies a high true-positive (50%) and low false-positive (0%) rate of cis-platinum-induced hearing loss. Using this criterion, cis-platinum ototoxicity affected 77% of children who received cis-platinum (median cumulative dose 360 mg/m2).

A three-stage method is proposed for allocation of hearing handicap. First, for a given injury or noise exposure period, the percentage of loss allocable for each ear is calculated as a simple ratio of hearing change (after age correction) to final hearing level. Second, final hearing handicap is divided between the two ears using a formula derived from the 1979 AAO-HNS/AMA standard. The percentage of hearing handicap allocable to a given period for each ear is simply the product of that ear's scores from the first two steps.

Otologic referral is an important component of an industrial hearing conservation program. Recent federal regulations in this area are reviewed, and suggestions for implementation of otologic referral are made. Criteria for otologic referral must be distinguished from a definition of significant threshold shift for internal program action. Test-retest variability is higher in industrial than in clinical settings, and unduly stringent definitions of significant threshold shift will result in many spuriously identified cases. The American Council of Otolaryngology--Head and Neck Surgery has proposed criteria for otologic referral that are probably the best available guidelines. Referrals should be made on the basis of both baseline and periodic audiometry. Most workers referred for substantial audiometric abnormalities have otologic diagnoses other than noise-induced hearing loss, or require specific intervention, or both.