Chemotherapy is a powerful weapon against cancer, but it can also have lasting side effects. One that’s often overlooked is hearing loss (ototoxicity), which can significantly impact your quality of life and, in many cases, cannot be reversed. Certain chemotherapy drugs, especially those with a platinum-base like cisplatin, carboplatin, and oxaliplatin – often used to treat cancers like ovarian, lung, and colorectal – can damage the delicate structures in the ear responsible for hearing and balance. This article will guide you through understanding the risks, preventative measures you can take, and the treatment options available to manage chemotherapy-induced hearing loss.

Chemotherapy drugs cause sensorineural hearing loss, not dissimilar to that caused by excessive and loud noise. Ototoxicity (damage to the cochlear by a toxin) is a well known side-effect of platinum-based chemotherapy, especially cisplatin. It can result in a temporary or permanent sensorineural hearing loss, generally in the upper speech frequency range. The hearing loss is caused by the destruction of delicate hair cells, known as stereocilia, inside the cochlear. Unfortunately for many, these important structures do not regenerate in humans. Once these hair cells are damaged, they cannot be repaired.

The incidence of ototoxicity has been reported to be as high as 20-84% in adults following treatment with platinum-based chemotherapy drugs. The risk is even higher rates in children as they are generally treated with higher dosages than adults.

Going through chemotherapy can be a long, arduous, and anxiety producing process. It can consume all of your thoughts and energy. In normal times, we tend to take our hearing for granted. During these stressful times, it is well off our radar screen. However, our ability to hear and understand is critical to a healthy and productive life going forward and it is not something we want to lose during our fight against the cancer.

With their focus on treating the disease, oncologists may not always explicitly discuss the potential side-effect of hearing loss. It therefore becomes the patient’s responsibility to think about their hearing health at times during their treatment cycle. Ignoring your hearing loss can have serious consequences, compounding the many physical and emotional challenges you’re already facing during cancer treatment.

Taking Control of Your Hearing Health During Chemotherapy

The best approach is to be proactive about your hearing health. Ideally, one to two weeks prior to starting chemo have your hearing checked by a specialist. In most areas, audiologists and hearing specialists will provide a hearing test at no cost to you. Get and keep a copy of your audiogram as this will act as your pre-treatment hearing base-line. These base-line results are important as they will be the basis for identifying any degradation of your hearing during and post-treatment.

Towards the middle of your treatment, have another hearing test and compare the results with your base-line. If there is a difference, review the tests with your oncologist who may be able to move you to a less ototoxic drug or adjust the dosages to minimize further damage.

A few weeks after your last chemo, have another hearing test and again compare it to your base-line results. If you see a difference, you need to discuss the severity of the loss with your audiologist and discuss what options are available to you for remediation. As we said earlier, chemotherapy-based hearing loss is generally not reversible and untreated hearing loss can truly complicate an already complicated life.

Hearing Loss Remediation Options

Untreated hearing loss, regardless of the cause, can rob us of social engagement, academic achievement, career advancement, and the enjoyment of everyday sounds. In fact, it can lead to early dementia and other cognitive impairments. A study by Johns Hopkins found that “mild hearing loss doubled dementia risk. Moderate loss tripled risk and people with severe hearing impairment were five times more likely to develop dementia.” Additionally, since our ears pick up subtle cues that help us maintain our balance, a hearing loss could interfere with our ability to walk safely.

There are several strategies to manage and diminish the effects of hearing loss:

Hearing Aids

For those with sensorineural hearing loss, regardless of the origin, hearing aids are the primary means of remediation. For those with mild to moderate hearing loss, many of the over-the-counter hearing aids could provide an inexpensive solution that can help you better hear and understand speech. While they can be purchased without any professional assistance, they are less customizable than those fitted by an audiologist. If OTC hearing aids are your choice, it is best to have a professional evaluation to rule out any other underlying issues.

For those with moderate to severe hearing loss, a professional evaluation is important. An audiologist can help you evaluate your hearing loss, the amplification power necessary to over come it, as well as the number of channels that would work best to improve your hearing and speech understanding. Since chemotherapy generally affects the ability to hear the higher-frequency sounds it is important to have hearing aids that are tailored to this. The reason is that most of the consonant sounds are both soft (try making a loud /f/ sound) and lie at the higher speech-frequency range. Not being able to discern these sounds creates difficulty in understanding. Some people might say “they can hear you talking, but can’t understand the words you’re saying”.

While hearing aids are not perfect, they help to regain functional hearing making it easier to follow conversations. Hearing aids reduce the mental effort necessary to understand speech, freeing up cognitive resources for memory and processing the words you can now hear.

Hearing aids also improve social well-being by reducing social isolation and reducing the risk of depression and anxiety associated with untreated hearing loss.

Why do so many people resist wearing hearing aids?

Would you believe that among US adults with a hearing loss, only about 30% actually use hearing aids. This means that approximately 70% of individuals with hearing loss either do not use hearing aids or do not use them on a regular basis. The reasons are varied:

  • Some people expect that hearing aids will fully restore their hearing and are disappointed when it is not the case. Hearing aids are just that, aids, that help restore functional hearing. It is beyond today’s technology to restore hearing to pre-loss levels – regardless of what the advertisements say!
  • Many feel that the aids do not provide enough improvement, especially in noisy environments which is difficult even with pre-loss hearing.
  • Some users find them difficult to handle (installing batteries, wax filters, etc.), this is especially true for those with neuropathy in their hands and fingers. 
  • Many are concerned that being seen wearing hearing aids will make them appear old.
  • For some, the expense of hearing aids is a significant deterrent. Hearing aids, especially for those with more severe loss are expensive and are generally not covered by insurance. While OTC hearing aids could cost as little as a few hundred dollars, others can cost up to $8,000 for a pair.

Other than hearing aids, what else is there?

Hearing aids are the gold standard for treating hearing loss but some people either don’t want to wear them or circumstances are such that alternatives are sought:

  • Sodium Thiosulfate (Pedmark/Pedmarqsi) – FDA-approved since 2022 for preventing hearing loss in children receiving cisplatin chemotherapy. Clinical trials show it reduces the risk of hearing loss by more than 50% in children. Research is ongoing to adapt similar medications for use in adults. This is a preventive measure that is prescribed prior to the beginning of chemotherapy.
  • Bone Conduction Devices – These devices transmit sound vibrations through the bones of the skull directly to the inner ear, bypassing the outer and middle ear. They work well for people with conductive hearing loss (chronic ear infections, osteoarthritis, etc.) but not so well with the sensorineural hearing loss caused by chemotherapy. Some bone conductive devices are used by people with hearing aids instead of traditional headphones which often cause irritating feedback noises.
  • Bone-Anchored Hearing Aids – unlike hearing aids, bone-anchored hearing devices are surgically implanted and use bone conduction to send the sound vibrations directly to the inner ear. These are considered specialty devices for people with unresolvable outer or middle ear problems.
  • Personal Sound Amplification Devices – these are generally specific use products that attach to the TV or sound system and transmit to wireless headphones or ear buds. Since they amplify all frequencies equally, just making the sound louder, they may work for people with mild hearing loss but may be bothersome to others.
  • FM Systems – these work by providing the speaker with a wireless FM microphone which transmits directly to the FM receiver worn by the listener. Many schools and universities utilize FM systems to assist those who have difficulty hearing the lectures. FM systems are expensive, and the use of personal FM systems are always at risk for loss of either the microphone or headset.
  • Cochlear Implants – for those with severe hearing loss where the cochlear and/or the stereocilia are damaged. Cochlear implants bypass most of the ear’s structures, including the cochlear, and stimulate the auditory nerve directly. Cochlear implants require a surgical procedure to implant the device and connect it to the auditory nerve.

New and Upcoming Treatments

New treatments for chemotherapy-induced hearing loss focus on preventing damage, especially in children, with ongoing research to expand options for adults and improve targeted drug delivery to the inner ear. This research is ongoing and treatments are not yet widely available. Check with your audiologist to see if there are any clinical trials going that you would qualify for.

  • Hydrogels and Nanoparticles: Researchers have developed targeted systems to deliver protective drugs directly to the inner ear, aiming to prevent cisplatin-induced damage while minimizing systemic side effects. Early-stage studies in cell lines and animal models show promising results.
  • Glutathione Peroxidase Mimics (e.g., SPI-1005/SPI-3005): These drugs reduce oxidative stress and inflammation – prominent contributors to hearing loss – in the cochlea and are in clinical trials for noise-induced and chemotherapy-induced hearing loss.

The Take-Away

While most oncologists are aware of the ototoxic effects of platinum-based chemotherapy drugs, the risk of hearing loss may not always be explicitly discussed with patients prior to starting treatment. It is possible, however, in the high-adrenalin state of the patient, this small (?) detail may have been missed. In either case, it is important for the patient to keep a clear head and take control of their hearing health while letting their oncology team treat the cancer.

Taking control means to schedule and remember to have a hearing test to create a base-line audiogram that can be referenced throughout their chemotherapy and then to have at least one hearing test during and one after the chemo is complete. If the mid-cycle test shows any indication of a hearing loss, it needs to be discussed with the oncologist who could adjust your treatment to minimize any additional hearing loss.

It is strongly recommended that every chemo patient discuss their concerns about hearing loss with their oncologist and seek professional audiological evaluations before, during, and after their chemotherapy cycle. Remember, your during this time your hearing health is a TEAM effort: you, the patient, your oncologist, and your audiologist.

Every chemo patient must remember that fighting the cancer is job number one. Maintaining your hearing needs to be a close second.