Hearing Loss and Tinnitus After Cancer Treatment

Cancer treatment can damage hearing. Doctors call this ototoxicity, which means damage to the ear caused by a medicine or other treatment. Some of the damage is permanent. Some of it can be reduced. This page covers which treatments carry the risk, what testing looks like, and what helps once hearing has changed.

Cisplatin is the drug most often responsible. It is a platinum chemotherapy drug. The National Cancer Institute lists it as a treatment for bladder cancer, ovarian cancer, and testicular cancer. It is also part of chemotherapy for childhood cancers such as hepatoblastoma, a liver tumor.

The warning on the drug is direct. MedlinePlus states that cisplatin "may cause serious hearing problems, especially in children," and that "hearing loss may be permanent in some cases."

Children carry the highest risk. NCI reports that cisplatin causes permanent hearing loss in up to 75% of children who receive it. In a young child this is not only a hearing problem. NCI notes that hearing loss can cause delays in learning and in social and emotional development.

Adults are affected too, and many do not notice at first. An NCI-supported study tested 273 survivors of lung, breast, gastrointestinal, and gynecologic cancers, on average about 4.5 years after diagnosis. Survivors badly underestimated the problem. At the outset, 30% said their hearing had changed. Audiograms corrected for age and sex told a different story. More than half of those given taxane drugs only had hearing loss, as did up to 70% of those given platinum drugs alone. Up to 40% had tinnitus. That was counted as being aware of it for 10 minutes or more of their waking time.

Other things add to the damage. The National Institute on Deafness and Other Communication Disorders (NIDCD) lists loud noise, aging, ear infections, earwax, head and neck injury, and several medicine groups as causes of ringing in the ears. Those groups include anti-cancer drugs, certain antibiotics, anti-malaria drugs, antidepressants, and painkillers such as ibuprofen, naproxen, and aspirin. Bring your full medicine list, including anything you buy without a prescription, when hearing changes.

NIDCD defines tinnitus as "the perception of sound that does not have an external source, so other people cannot hear it." People describe ringing, buzzing, hissing, roaring, or clicking. Surveys estimate that 10% to 25% of adults have it. Children get it as well.

Most tinnitus is subjective, which means only you can hear it. Rarely it is objective, and a doctor can hear it through a stethoscope. Tinnitus is a symptom rather than a disease, and it often travels with hearing loss.

Contact your care team the same day, or go to urgent care, if hearing drops suddenly in one or both ears.

NIDCD describes sudden sensorineural hearing loss as an unexplained, rapid loss of hearing, either all at once or over a few days. Doctors define it as losing at least 30 decibels across three connected frequencies within 72 hours. Speech that was clear yesterday sounds like a whisper today.

NIDCD is blunt about what to do. It says "you should consider sudden deafness symptoms a medical emergency and visit a doctor immediately." Waiting lowers the chance that treatment works. Corticosteroids are the most common treatment, and NIDCD says they should be used as soon as possible. Treatment delayed more than two to four weeks is less likely to reverse or reduce permanent hearing loss.

About half of people with sudden hearing loss recover some or all of it on their own, usually within one to two weeks. That is not a reason to wait and see.

If you are receiving cisplatin, MedlinePlus advises calling your doctor right away for hearing loss, ringing in the ears, or dizziness.

The main test is an audiogram. An audiologist plays tones at different pitches and volumes and records the softest sound you can hear at each pitch. It does not hurt. Versions exist for babies and for small children who cannot raise a hand on cue.

MedlinePlus says your doctor will check your hearing before and during cisplatin treatment. NCI researchers make the same point for adults. Clinicians should ask about symptoms and test routinely with audiograms before and after treatment.

Ask for a baseline test before the first dose. Without a baseline, a later result cannot show how much has changed.

Sodium thiosulfate (brand name Pedmark) is approved by the FDA to lower the risk of hearing loss in children given cisplatin. Approval covers patients aged 1 month through 18 years with localized tumors, meaning the cancer has not spread beyond the tissue or organ where it began.

It is given as an intravenous infusion over 15 minutes, after a cisplatin infusion that can run up to 6 hours.

It helps, but it does not remove the risk. In a Children's Oncology Group trial, 44% of children given sodium thiosulfate developed hearing loss, compared with 58% of those who were not. In a UK-led trial the figures were 39% and 68%. NCI notes that more research is needed before the drug is used in children whose cancer has spread.

Ototoxic drugs cause sensorineural hearing loss. That means damage to the small sensory cells in the inner ear, called hair cells. Hearing aids are the main treatment for this type of loss.

NIDCD describes three main styles. Behind-the-ear aids suit all ages and every degree of loss, from mild to profound. In-the-ear aids fit inside the outer ear and are used for mild to severe loss. Canal aids sit in the ear canal and suit mild to moderately severe loss.

Over-the-counter hearing aids can be bought without seeing a hearing professional. They are meant for adults with mild to moderate loss. Prescription aids are programmed by a professional for your exact pattern of loss, and NIDCD says they are needed for more significant or complicated hearing loss. Ask your audiologist which type fits your audiogram.

Hearing aids take time and patience. Expect a few weeks of adjustment. Many public buildings have induction loop systems, and a telecoil in your hearing aid lets you pick up sound directly through that system.

There is no FDA-approved medicine for tinnitus itself. NIDCD lists what does help: hearing aids, sound generators, cognitive behavioral therapy, and tinnitus retraining therapy, which combines counseling with sound therapy. Medicines are sometimes used for the mood and sleep problems that come with tinnitus, not for the sound.

Be careful with products sold as tinnitus cures. NIDCD says of vitamins, herbal extracts, and dietary supplements that "none of these has been proven to be effective."

Under the Americans with Disabilities Act, organizations must provide auxiliary aids and services so that communication is effective. For people who are deaf or hard of hearing, the Department of Justice names a qualified notetaker, a qualified sign language interpreter, real-time captioning, written materials, or a printed script.

State and local government bodies, which include public schools, must give primary consideration to the aid the person actually asks for. As a rule you should not be asked to bring a family member to interpret. DOJ allows only narrow exceptions, such as an imminent safety threat with no interpreter available, and children are not to be used as interpreters.

For a student with cancer, the Department of Education's Office for Civil Rights lists Section 504 accommodations that also help with hearing loss. Examples include preferred seating, extra time to travel between classes, and permission to make up work without penalty.

• Which of my drugs are ototoxic, and what is my total planned dose?
• Have I had a baseline audiogram, and when is the next one due?
• Does sodium thiosulfate apply to my child's tumor type and stage?
• Is my hearing loss sensorineural, and which pitches are affected?
• Should I see an ear, nose, and throat doctor as well as an audiologist?
• What should I do if hearing drops suddenly at night or on a weekend?
• Will hearing aids be covered by my plan, and who orders the referral? .

• Sodium Thiosulfate Reduces Hearing Loss in Kids with Cancer — National Cancer Institute
• Common Chemotherapy Drugs Seem to Increase Hearing Loss in Some Adults — NCI Division of Cancer Prevention
• Cisplatin Injection — MedlinePlus
• Tinnitus — National Institute on Deafness and Other Communication Disorders
• Sudden Deafness — National Institute on Deafness and Other Communication Disorders
• Hearing Aids — National Institute on Deafness and Other Communication Disorders
• ADA Requirements: Effective Communication — U.S. Department of Justice
• Section 504 Protections for Students with Cancer — U.S. Department of Education, Office for Civil Rights .