목적: Platinum-based chemotherapies, notably cisplatin and carboplatin, are vital in treating pediatric malignancies. However, their use is frequently associated with ototoxicity, resulting in permanent hearing loss which can impact the quality of life of cancer survivors. Especially for children, hearing loss affects their cognitive and psychosocial development. This study aims to evaluate the incidence and severity of platinum-based ototoxicity in Korean pediatric oncology patients and to analyze potential risk factors associated with the development of hearing loss in children with cancer. 방법:A retrospective cohort analysis was conducted across three major tertiary care centers from 2004 to 2024, encompassing 377 pediatric oncology patients treated with platinum-based regimens for a variety of malignancies. Patients were diagnosed before the age of 19. Audiological assessments, including pure-tone audiometry (PTA), auditory brainstem response (ABR), and distortion product otoacoustic emissions (DPOAE), were used to evaluate hearing thresholds before, during, and following chemotherapy. Hearing loss was defined as a threshold shift of 25dB or more in any frequency. Demographic data, tumor types, chemotherapy duration, chemotherapy regimen and additional cranial irradiation were extracted. Statistical analyses identified significant risk factors for ototoxicity. 결과:In total, 212 patients met the inclusion criteria. Median age at diagnosis was 8.2 years. 178 patients had received cisplatin, 87 received carboplatin, and 59 received both agents. Ototoxicity was reported in 110 patients (51.9%). Among these, 90 (81.8%) had received cisplatin, 56 (50.9%) had received carboplatin, and 38 (34.5%) had received both agents. Notably, among the 59 patients who received both cisplatin and carboplatin, ototoxicity was observed in 64.4%. The incidence of ototoxicity was highest in CNS tumors, with medulloblastoma (n=36, 32.7%) being the most prevalent, followed by neuroblastoma (n=27, 24.5%) and sarcoma (n=22, 20%). In terms of radiation therapy, 49 (44.5%) had received radiotherapy targeting the head and neck region. However, the mean radiation dose did not significantly differ between those who developed ototoxicity (40.1 Gy) and those who did not (39.8 Gy). Additionally, ototoxicity was significantly more prevalent in males (n=78, 70.1%) than in females (n=32, 29.1%), with a male-to-female ratio exceeding 2:1. Moreover, younger children appeared to be more vulnerable, as 30 patients (45.5%) under the age of five were affected, highlighting a combined effect of sex and age as potential risk factors. 결론:This study underscores the high prevalence of platinum-induced ototoxicity in pediatric patients, with severity influenced by tumor type, chemotherapy regimen, and concurrent cranial irradiation. Our findings support previous studies suggesting that male sex and younger age, particularly under five years old, may be risk factors for ototoxicity. Further research is warranted to validate these associations in larger cohorts. Regular hearing evaluation is essential for the early detection of ototoxicity. Prevention strategies, including the use of otoprotective agents, can be considered. Furthermore, long-term follow-up is also recommended, particularly for patients with identified risk factors for hearing loss. Findings emphasize the importance of routine auditory monitoring and the potential role of otoprotective measures to preserve hearing and improve quality of life for pediatric cancer survivors.