Some cancers and cancer treatments may cause hearing loss or ringing in the ears, also called tinnitus. Hearing loss and tinnitus from cancer and cancer treatment can range from mild to severe and may happen together or separately. Hearing problems may go away after cancer and treatment, or they might be lifelong.
In a recent study, half of the people who had received chemotherapy experienced significant hearing loss, but they were not always aware of the damage. If you have had cancer treatments that can affect your hearing, regular hearing tests can help you catch hearing problems early and get help.
Hearing problems can affect your quality of life. Tell your health care team about any changes in your hearing, either during or after your treatment. They may be able to treat the problems and any other side effects you have. This type of treatment is called palliative or supportive care, and it is an important part of your overall cancer care no matter your age or type or stage of cancer.
What are the types of hearing problems?
Your ear has 3 main parts: the outer ear, which is the part you see, the middle ear, and the inner ear. Damage to any part of the ear can cause hearing problems.
There are 2 main types of hearing loss:
Conductive hearing loss. This happens when something blocks your outer or middle ear. Sound cannot reach the inner ear, which sends signals to your brain. Earwax or an ear infection can block the outer or middle ear. Medical treatment can often fix this type of hearing loss.
Sensory nerve hearing loss. This happens when your inner ear or auditory nerve is damaged. The auditory nerve connects the ear to your brain. Damage to the inner ear or auditory nerve is often permanent.
There are 2 main types of tinnitus:
Subjective tinnitus. You are the only one who can hear the tinnitus sounds. These can be in the form of ringing, whooshing, humming, buzzing, clicking, hissing, or other sounds. They come from damage to any part of the ear or the hearing nerves.
Objective tinnitus. Your doctor can hear the tinnitus sounds, too. Several different health conditions can cause this rare form of tinnitus. They include problems with a heart valve or your blood vessels, and muscle tightening.
What are the causes of hearing problems?
Causes of hearing problems can include the following.
Chemotherapy. Some types of chemotherapy can damage your inner ear. These include platinum-based drugs such as cisplatin (Platinol) and carboplatin (Paraplatin) and taxanes such as paclitaxel (Taxol) and docetaxel (Taxotere).
Tinnitus is often the first sign of damage caused by chemotherapy. You might also lose hearing when the drug damages the inner ear cells. These hearing problems usually happen in both ears. Hearing loss from chemotherapy is usually permanent, but the use of a hearing aid may help.
Radiation therapy. High doses of radiation therapy to the head, ear, or brain can damage the inner ear. Radiation therapy can also cause middle and outer ear problems and side effects. These may include inflammation, earwax blocking the ear, fluid building up, and stiff ear bones. All these can affect your hearing. You might have this hearing loss in one or both ears, depending on the treatment you receive.
Surgery. Surgery on the brain, ear, or auditory nerve can cause hearing problems.
Commonly used medications. Many medications you take along with cancer treatment can damage the inner ear. Using several of them together raises the risk for hearing loss and tinnitus. This is more likely if you take large doses for a long time. Medications that can damage your inner ear include:
Certain antibiotics. Ask your doctor or pharmacist if the antibiotics they prescribe could cause hearing loss. These antibiotics include erythromycin, neomycin, gentamicin, streptomycin, and tobramycin. They have many brand names, so checking with your doctor or pharmacist is very important.
Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve). "NSAIDs" is another name for these types of drugs.
Other medications. There are other medications that can cause hearing problems. These include:
Aspirin, taken in large amounts.
Certain diuretics (water pills), such as furosemide (Lasix) and ethacrynic acid (Edecrin)
Some heart and blood pressure medications, such as metoprolol (Lopressor)
Some anti-nausea medications, such as promethazine (Phenergan)
Conditions that are not cancer. Many other conditions cause hearing problems, including benign ear tumors, ears that are shaped differently than normal, head trauma, viruses, and allergies. Aging and exposure to loud noise can also cause these problems.
Who is at risk for developing hearing problems from cancer and cancer treatment?
Some people have a higher risk of developing hearing problems from cancer treatment than others. These factors may put you at a higher risk for developing hearing problems after cancer or cancer treatment:
Age. Children younger than 4 years old who receive cancer treatments that can cause ear damage are more likely to have hearing problems. Older adults are also more likely to have hearing problems from cancer treatment. This is because they are more likely to have existing hearing problems or a high risk of hearing problems before cancer treatment.
The type of cancer treatment you receive. People who receive these cancer treatments are at a high risk of developing hearing problems:
High doses of the chemotherapy drugs cisplatin or carboplatin
High doses of radiation to the ear, brain, nose, sinuses, throat, or the area behind the cheekbones
A combination of treatments that may cause ear damage, such as cisplatin and radiation therapy to the brain
A tumor, surgery, or infection of your brain, ear, or auditory (hearing) nerve
People who have co-existing conditions. A co-existing condition is any medical condition that you have in addition to cancer. Some of these conditions can put you at a higher risk for developing certain side effects, like hearing loss or tinnitus. You are also more likely to develop more hearing problems if you have had hearing problems in the past.
Knowing that you at a higher risk of developing hearing problems can help your health care team monitor your hearing. Talk to your doctor about your personal risk factors for hearing problems during cancer.
What are the symptoms of hearing problems?
You might have some of these symptoms:
Nausea or vomiting
Vertigo, which is a spinning or off-balance feeling
Hearing sounds inside your ear, sometimes or all the time
Noticing that people's voices sound different or quieter than normal
Having difficulty hearing because of background noise
Being unable to hear someone on the phone
Needing the TV, radio, or other device volume turned up very high
Avoiding people and activities because of hearing problems
Talk with your health care team if you have any of these symptoms. Also tell them about any changes in your symptoms regularly, or if a new problem appears. If cancer treatment is the cause, your doctor may be able to change your treatment or give less intense treatment. They can also talk with you about other ways to help.
How are hearing problems diagnosed?
Your health care team might do tests to find the cause of hearing problems during cancer treatment. This may include seeing a specialist, such as an otologist. This is a medical doctor who specializes in ear problems. You might also see an audiologist. This is a health care professional who does tests for hearing problems.
You might have 1 or more of the following tests:
Physical examination. Your doctor will look in your ears for problems such as a blockage or infection. They might also test your nerves, because hearing is part of your nervous system. This may include looking in your eyes, testing your strength and reflexes, and checking your balance.
Audiogram. An audiologist will ask you to listen and respond to different sounds. This helps tell your doctor if you have hearing loss, how much, and which sounds are difficult for you to hear.
Brainstem auditory evoked response, or BAER. You might have this test if you are not able to follow the instructions for an audiogram. It measures how your brain reacts to certain sounds.
Imaging tests. You might have a computed tomography (CT) scan or magnetic resonance imaging (MRI) test. These tests create pictures of the inside of the body.
How are hearing problems prevented, treated, and managed?
For children who receive cisplatin, the U.S. Food and Drug Administration (FDA) has approved sodium thiosulfate (Pedmark) to reduce chemotherapy-related hearing loss. It is approved for children 1 month and older who have a solid tumor that has not spread.
For people who are already experiencing symptoms of hearing loss, something may be blocking your hearing. Ear drops, ear wax removal, or surgery may help. These treatments might also help tinnitus. But so far, there is no cure for tinnitus.
Nerve-related hearing loss is often permanent, too. But there are ways to manage hearing problems effectively during and after cancer treatment. Be sure to talk with your health care team to learn more.
Tips for managing hearing problems
The following can help you manage hearing problems:
Ask your health care team if you should avoid alcohol, tobacco products, and caffeine, which can make tinnitus worse.
Drink plenty of water and other fluids. Dehydration can also make tinnitus worse.
Ask friends, family members, and co-workers to speak clearly without yelling. Yelling or shouting can make it harder to hear and damage ears further.
Practice relaxation techniques and get lots of sleep. Being stressed or tired can make tinnitus worse.
Control your blood pressure. High blood pressure can cause hearing problems.
Ask your doctor about medications for nausea or dizziness if you have these problems.
Protect your ears from loud noises. Loud noise can make hearing problems caused by chemotherapy or other drugs worse.
Devices to help with hearing problems
Your doctor may suggest using one of the following devices:
Hearing aids. These small devices make sounds louder. You wear them in your ear or behind it. They can also make tinnitus less noticeable when you increase the background noise level using the device.
Sound generators. These devices create sounds that cover up the sounds of tinnitus, so it bothers you less. You can get one that includes a hearing aid.
Devices for your home or office. These devices also cover up the sounds of tinnitus, but you put them nearby instead of wearing them. Examples include “white noise” machines and apps that play music or nature sounds.
Auditory (hearing) trainers. This is a device you wear in a room where one person is speaking, such as a classroom. The speaker wears a microphone and you wear a small device that makes their voice easier to hear.
Cochlear (inner ear) implants. This is an electronic device that a doctor implants in your inner ear. It works like the natural inner ear to help people with serious hearing loss hear again.
Watching for hearing problems after treatment
If your cancer treatment raises your risk of hearing problems, have your hearing tested at least once after treatment ends. Your health care team may recommend testing more often. How often you need it depends on the type of cancer treatment you received.
Questions to ask the health care team
Consider asking your health care team these questions about hearing problems:
Am I at an increased risk of developing hearing problems?
Are hearing problems a common side effect of the cancer that I have or the treatment I will receive?
Will I need any tests to diagnose hearing problems?
What treatment options are available for the hearing problem that I have?
What is causing my hearing problem?
Who should I talk to about any hearing problems or other side effects I am experiencing? How soon?
How can I get in touch with them during business hours and after hours?
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