Cancer treatments, while essential for saving lives, can lead to hearing and balance problems known as ototoxicity. This issue is particularly associated with certain chemotherapy drugs, radiation therapy, and some surgical procedures.
Chemotherapy drugs are widely used in cancer treatment and can sometimes be harmful to hearing. Platinum-based chemotherapies, especially cisplatin, are among the most well-known for causing hearing loss. According to a review article in Cancer Chemotherapy and Pharmacology, cisplatin is commonly used to treat cancers such as bladder, testicular, and ovarian cancer in adults. In children, it may be used for brain, liver, and bone tumors.
Hearing-related side effects from cisplatin are common. The American Speech-Language-Hearing Association (ASHA) notes that permanent hearing loss occurs in about half of all patients who take this drug. A 2024 study published in JAMA Oncology found that nearly 80% of testicular cancer patients developed hearing loss after receiving cisplatin; those at higher risk included older individuals, those given higher doses of the drug, or those with high cholesterol.
Children are particularly vulnerable to the effects of these drugs. A University of British Columbia study from 2021 showed that 75% of patients five years old and younger had cisplatin-related hearing loss three years after starting therapy. As noted in a 2016 review article in Cancer: “Young children [are] particularly vulnerable to the ototoxic effects of cancer therapies.” The developing brain and ears make young children more susceptible to damage.
Scientists believe that cisplatin may cause hearing loss because it enters the inner ear easily but does not exit efficiently. Once inside the ear, it can damage hair cells vital for hearing.
Other platinum-based chemotherapies like carboplatin and oxaliplatin are less likely than cisplatin to harm hearing but can still cause issues such as tinnitus. Additional chemotherapy agents—including vincristine, doxorubicin, gemcitabine, cyclophosphamide, oxaliplatin, and farmorubicin—have also been linked to hearing problems or tinnitus.
Radiation therapy increases the risk when combined with ototoxic chemotherapy medications. Radiation directed at the head or neck can lead to two types of hearing loss: conductive (caused by changes such as narrowing of the ear canal or thickening of the eardrum) and sensorineural (resulting from damage to the inner ear or auditory nerve). According to a 2019 article in the Journal of Neurologic Surgery, almost half of people who receive radiation therapy in these areas develop fluid buildup in the middle ear (otitis media with effusion). Higher doses increase risk; those under age three or over age fifty face greater susceptibility.
Surgical procedures involving areas near the brain, ear, or auditory nerve may also result in hearing problems if tumor removal damages these structures.
Monoclonal antibodies (mAbs), which modify immune system responses against cancers like prostate, colon, lung, ovarian cancers and blood cancers, have been linked with reversible hearing issues including tinnitus and aural fullness due to possible inflammation within the inner ear.
Non-cancer medications taken during treatment—such as painkillers or antibiotics—can also contribute to hearing problems. Over 200 medications have been associated with potential hearing loss risks.
When considering cancer treatment options doctors must weigh life-saving benefits against possible side effects like permanent or temporary hearing impairment. ASHA recommends several steps for those undergoing potentially ototoxic treatments: checking baseline hearing before treatment begins; monitoring changes throughout therapy; getting regular checkups afterward—especially important for pediatric patients—and discussing alternative therapies if concerned about risks.
Researchers continue exploring "otoprotective agents" designed to protect against drug-induced hearing loss without reducing chemotherapy effectiveness. For example sodium thiosulfate has shown promise limiting cisplatin-related damage in children according to ASHA reports.
If permanent hearing loss occurs following cancer treatment experts recommend consulting a qualified provider about solutions such as hearing aids, cochlear implants or assistive listening devices.
“It’s very important to talk to your oncologist about the benefits and risks of the treatments you’re receiving,” states guidance provided on managing these side effects.
“Check your hearing: Ideally do this before treatment… Track changes: An audiologist can help you monitor… Get check-ups: Even after cancer treatment ends it's a good idea…” advises ASHA on best practices for minimizing long-term impact.
“Young children [are] particularly vulnerable…” affirms a review article cited above regarding pediatric cases.
