4 Causes of Hearing Problems for Cancer Survivors

Hearing problems are a common long-term side effect of some cancer treatments, especially for children and older adults. Sometimes treatment can lead to temporary or permanent hearing changes. But if you develop hearing problems during cancer treatment, spotting symptoms early and talking to your cancer care team can help you get the support you need.

“Hearing loss can significantly impact quality of life, communication, and emotional well-being, making daily activities and social interactions more difficult. Early identification and management are crucial to minimize disability and support a patient’s overall recovery and survivorship,” said Kedar Kirtane, MD, an American Society of Clinical Oncology (ASCO) expert and medical oncologist at Moffitt Cancer Center.

Can cancer cause hearing loss?

Cancer itself is unlikely to cause hearing loss. But certain types of cancer treatments can have that effect. These are known as ototoxicity or auditory effects. The treatments can damage nerves or the parts of your inner ear that help you hear or keep your balance.

Treatments that can be ototoxic include:

1. Surgery to treat cancers near the ear or those that affect the auditory system. This includes the inner and outer structures of the ear, nerves, and processes that allow you to hear. Depending on the extent of the surgery, hearing may be affected.
2. Platinum-based chemotherapy (chemo). This type of chemo contains heavy metals that can damage nerves that allow you to hear. Examples of platinum-based chemo medicines include cisplatin, carboplatin, and oxaliplatin. These medicines are commonly used to treat many types of cancer, including head and neck cancer, ovarian cancer, and lung cancer. Temporary or permanent hearing changes are a known long-term side effect of this treatment.
3. Radiation therapy to the brain, head, or neck. Radiation affects only the area where the radiation beam is directed. When radiation therapy is given in the brain, head, or neck, the cochlea can be damaged. The cochlea is the inner part of the ear that helps you hear. Damage to this area can lead to hearing loss, which can be permanent.
4. Antibiotics. People with cancer sometimes take antibiotics to prevent or treat an infection. For example, infections caused by the bacteria E. coli or Klebsiella can be treated with antibiotics called aminoglycosides. This type of antibiotic has the highest risk for hearing changes. If the person is also receiving a cancer treatment that can cause hearing problems, the risk is even higher.

Before starting treatment, ask your doctor whether it might lead to any hearing problems. If so, ask if there are ways to prevent them or reduce their impact.

Symptoms of hearing changes

If you experience any changes to your hearing or balance, tell your doctor right away. “Some hearing loss may be reversible if addressed early,” said Dr. Kirtane.

Symptoms of hearing changes include:

• Trouble hearing high-pitched sounds
• Hearing that sounds different than normal
• Tinnitus or ringing in your ears
• Dizziness or feeling off-balance

Hearing loss in children with cancer

Children with cancer may be at especially high risk for hearing loss after treatment. This can interfere with their development and quality of life.

“In children, hearing is crucial for proper speech development and future communication abilities. Of course, hearing is also important for safety, like hearing alarms or emergency vehicles. For childhood cancer survivors, severe hearing loss has been associated with neurocognitive deficits that may impact learning and academic achievement,” said Daniel Mulrooney, MD, MS, an ASCO expert and pediatric oncologist at St. Jude Children’s Research Hospital.

It's important for children with cancer to get checked regularly for hearing problems. Otherwise, these issues can be missed, sometimes for years. Finding them early can help doctors recommend steps to limit the effects.

“In recent years, there have been significant advancements in hearing amplification,” said Dr. Mulrooney. Newer, smaller hearing aids are easier to wear. Cochlear implants are also now more available.

Depending on the extent of a child’s hearing loss, schools can often make helpful changes also. For example, a child may be able to sit closer to the teacher during class. Or the teacher can wear a device that amplifies their voice. “These options make it easier for children who struggle with or don’t want to wear devices,” said Dr. Mulrooney.

Hearing loss in older adults with cancer

People over the age of 65 who have cancer can also be at higher risk of hearing problems. “Older adults are at higher risk due to both age-related decline and increased sensitivity to cancer treatments, which can worsen preexisting hearing issues,” said Dr. Kirtane. “Regular hearing assessments and individualized support are especially important for this group to maintain their independence and cognitive health.”

No matter your age, talk to your doctor about whether your cancer treatment can impact your hearing⁠, even if you’ve finished treatment. If so, ask if the doctor recommends regular hearing tests. These tests can help your care team decide which measures make the most sense for you. “Protective strategies, hearing aids, and specialist referrals can all help manage symptoms,” said Dr. Kirtane.

Dr. Kirtane and Dr. Mulrooney are members of ASCO’s Patient Information Editorial Board.