Physicians are well aware of the many side effects of chemotherapy and radiation treatment. However, only in recent years has research addressed the risk of hearing loss and related conditions (e.g. tinnitus) as reported by numerous post-cancer treatment patients. These studies have revealed a strong link between cancer treatments and hearing loss, especially among certain chemotherapy medications. It is important for both physician and patient to understand the risk of ototoxicity when treating cancer, and its long-term implications, which may include permanent hearing loss.
Certain chemotherapy medications or radiation therapy can cause ototoxicity, which may be manifested as temporary or permanent hearing loss, depending on the type of treatment and the extent of the hearing damage. Ototoxicity resulting in sensorineural hearing loss (SHL) refers to drug or chemical damage to the inner ear where cochlear hair cells vibrate in response to sound waves. This damage may affect vital hearing and balance information to the brain, resulting in hearing loss, tinnitus, and/or loss of balance.
“Platinum-based chemotherapy medications, particularly cisplatin and carboplatin, are considered the primary culprits” when it comes to ototoxicity. Other potentially ototoxic chemotherapy drugs include Bleomycin, Vincristine, Vinblastin, Bromocriptine, and Methotrexate Nitorgen mustard.” 1
Chemotherapy from the “platinum” group is frequently used to treat brain, head, and neck cancers; as well as lung, bladder, and ovarian cancers in adults. It is also commonly used to treat brain, bone, and live cancers in children.
The most common ototoxic cancer treatments associated with hearing damage are platinum-based chemotherapy agents (cisplatin and carboplatin in particular) and radiation of head and neck.
Hearing loss and tinnitus are under-reported after effects of cancer treatment, especially in children.
The effects of untreated hearing loss on adults include:
In children, even mild hearing loss could result in delays in acquired language, compromised speech comprehension, learning deficits, and psychological and social difficulties.
It is crucial to involve a hearing care professional during and after cancer treatment to help monitor effect of exposure to ototoxic chemotherapy and offer treatment and rehabilitation, which may include hearing aids.
Because of the long-term effects of hearing loss in adult survivors, and the debilitating effects associated with the condition, oncologists will likely do their utmost to mitigate ototoxic exposure during treatment. When aggressive treatment is necessitated, and the patient experiences hearing loss, it is important to consider treatment options such as hearing aids, which can help 95% of patients with hearing loss. As cancer treatments have more success, and cancer patients live longer, hearing loss treatments have more success, and cancer patients live longer, hearing loss treatment, could improve the patient’s quality of life after cancer treatment.
“Twenty years ago, many patients considered themselves lucky to survive—now medical advances mean that quality of life after treatment is also crucial” 6
HFHL in children primarily affects comprehension, yet children may not realize they are not interpreting speech properly and so the condition goes underreported, and undiagnosed. Left untreated, consequences include: 8
“And that can lead to development issues. A study that evaluated the educational performance and social-emotional functioning of about 1200 children with minimal hearing loss revealed that 37% failed at least one grade in school compared with the normal 3%. They also had more problems with behavior, energy, stress, and self-esteem.” 9
Hearing loss can be a negative after-effect of certain chemotherapy medications and radiation therapy. While treatment is ongoing, an audiologist can assist with monitoring for ototoxicity and make recommendations for early intervention if possible. As medications improve, more treatment options become available, and survival rates continue to rise, the need for medical professionals to consider quality of life post-treatment becomes crucial. After treatment is complete, an audiologist should evaluate the patient for ototoxic after-effects and if necessary offer counseling, treatment—which could include hearing aids and rehabilitation.