Protective Effect of Acetylcysteine Against Cisplatinum-Induced Ototoxicity: A Randomized Controlled Trial

Inclusion Criteria: * Patients aged between 18 and 70 years * Patients scheduled to receive high-dose cisplatin-based chemotherapy regimens with a projected cumulative cisplatin dose of \> 200 mg/m2 and each dose \> 50 mg/m2 * Patients may receive concurrent chemotherapy with non-ototoxic agents * Patients may receive concurrent radiation therapy to the skull base, provided the radiation dose does not exceed the toxic threshold for ototoxicity * Patients receiving an appropriate antiemetic regimen consisting of Olanzapine or Neurokinin-1 (NK1) receptor antagonists * Patients receiving medical treatment at Siriraj Hospital. Exclusion Criteria: * Patients diagnosed with Nasopharyngeal Carcinoma (CA nasopharynx). * Patients with a history of head and neck radiation therapy where the radiation dose to the cochlea exceeded 9 Gy or the dose to the eustachian tube exceeded 50 Gy on both sides. * Patients who have received N-acetylcysteine (NAC) within 2 weeks prior to the start of the study. * Patients who have received other ototoxic drugs within 2 weeks prior to or during the study, including but not limited to: Aminoglycoside antibiotics, Vancomycin, Loop diuretics (e.g., Furosemide), High-dose Aspirin, Antimalarial drugs (e.g., Quinine) \- Patient with a known allergy or hypersensitivity to acetylcysteine.