Hearing Problems

Approved by the Cancer.Net Editorial Board, 09/2017

Some cancers and cancer treatments may cause hearing problems. These problems can include mild to severe hearing loss and tinnitus, a ringing in the ears. Hearing loss and tinnitus, which may occur separately or together, often go away when treatment ends. In some cases, damage to the ear is permanent.  

Hearing problems can affect your quality of life. Tell your health care team about any hearing changes that you experience during or after cancer treatment. Relieving these and other side effects is an important part of cancer care. This is called palliative care or supportive care.

Types of hearing problems

The ear has 3 main parts: inner, middle, and outer ear. Hearing problems begin when 1 or more of these parts cannot function properly.

There are 2 main types of hearing loss:

  • Conductive hearing loss. This occurs when a blockage in the outer or middle ear keeps sound waves from reaching the inner ear. This may because of earwax buildup or an ear infection. Medical treatment can often fix conductive hearing loss.

  • Sensorineural hearing loss. This type of hearing loss occurs when there is damage to the inner ear or auditory nerve. The auditory nerve carries hearing information from the inner ear to the brain. Inner ear damage is often permanent.

There are 2 main types of tinnitus:

  • Subjective tinnitus. This means that only the patient can hear the ringing, whooshing, humming, buzzing, clicking, hissing, or other sounds tinnitus can cause. Problems in any part of the ear or the hearing nerves can cause it.

  • Objective tinnitus. This is when the sounds a patient hears inside the ear can also be heard by the doctor. This rare form of tinnitus can be caused by several health conditions, including heart valve problems, blood vessel disorders, and muscular contractions.

Causes of hearing problems

Causes of hearing problems can include:

  • Chemotherapy. Medications that can damage the inner ear are called ototoxic. Certain types of chemotherapy are ototoxic. These include platinum-based drugs such as cisplatin (Platinol) and carboplatin (Paraplatin). The first sign of ototoxicity is often tinnitus. Hearing loss usually occurs when the drug damages the sensory hair cells in the inner ear that help process sound. Typically, it occurs in both ears.

  • Radiation therapy. High doses of radiation therapy to the head, ear, or brain can cause inner ear damage. Radiation therapy can also cause middle and outer ear problems. This may include inflammation, earwax blockages, fluid buildup, and  stiffening of the bones in the ear, which can affect hearing. This may occur in one or both ears, depending on the area receiving treatment.

  • Surgery. Surgery to the brain, ear, or auditory nerve can lead to hearing problems.

  • Commonly used medications. Many common medications that patients may take along with their cancer treatment can damage the inner ear. Using several ototoxic medications together, especially large doses for a long period of time, can increase the risk for hearing loss and tinnitus. 

    • Aminoglycoside antibiotics, such as erythromycin, neomycin, gentamicin, streptomycin, and tobramycin (all have multiple brand names)

    • Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil) and naproxen sodium (Alleve)

    • Aspirin taken in large amounts

    • Loop diuretics, 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)

  • Non-cancerous conditions. Many health conditions, including benign ear tumors, ear malformations, head trauma, viruses, and allergies, can cause hearing loss or tinnitus. Aging and exposure to loud noises can also be culprits.  

Who is at risk for developing hearing problems from cancer treatment?

People who may have a higher risk of hearing problems from cancer treatment include those who:

  • Were under age 4 when given treatments that may cause ear damage

  • Previously had hearing problems or had a higher risk of them before being diagnosed with cancer

  • Received high doses of cisplatin or carboplatin

  • Received a combination of treatments that may cause ear damage, such a radiation therapy to the brain combined with cisplatin

  • Received high doses of radiation therapy to the ear, brain, nose, sinuses, throat, or behind the cheekbones

  • Had kidney problems and received cancer treatment that can cause ear damage

  • Had a brain, ear, or auditory nerve tumor, surgery, or infection

Symptoms of hearing problems

People experiencing hearing problems may have some of these symptoms:

  • Lightheadedness

  • Nausea or vomiting

  • Vertigo, which is a sensation of spinning or feeling off balance

  • Hearing sounds inside the ear continuously or intermittently

  • Distortion or muffling of voices and sounds

  • Difficulty hearing when background sounds are present

  • Inability to hear someone on the phone

  • A need to turn up the volume on the television, radio, or other devices to very high levels

  • Withdrawal from social situations because of trouble hearing

Talk with your health care team about any hearing-related symptoms you experience and any change in symptoms. If your symptoms are being caused by cancer treatment, your doctor may be able to change your treatment or reduce the intensity of treatment.

Diagnosing hearing problems

If you experience hearing-related side effects during or after treatment, your health care team may perform tests to find the cause. If needed, your doctor may refer you to an audiologist or otologist. An audiologist is a health care professional who evaluates hearing loss and related disorders. An otologist is a health care professional who specializes in hearing disorders.

The following tests may be used to diagnose hearing problems:

  • Physical exam. Your doctor will look in your ears for visible problems, such as a blockage or infection. Because hearing is a part of your nervous system, the doctor may also perform a neurological exam. During this exam, the doctor may examine your eyes, test your strength and reflexes, and check your balance.

  • Audiogram. This hearing test has the patient listen and respond to sounds of different pitches and volumes through earphones. The test helps diagnose hearing loss and its severity. 

  • Brainstem auditory evoked response (BAER). This hearing test is used when a patient is unable to follow audiogram test instructions. The test measures the brain wave activity that occurs in response to clicks or certain tones. 

  • Imaging tests. In some cases, the doctor may order a computed tomography (CT) scan or magnetic resonance imaging (MRI) test, to better diagnose what is causing hearing problems. These tests create pictures of the inside of the body.

Treating and managing hearing problems

Conductive hearing loss can often be treated and restored with medical treatments such as ear drops, ear wax removal, or surgery. In some cases, tinnitus may also go away with these treatments. But, in general, there are no medical or surgical treatments for tinnitus. Likewise, sensorineural hearing loss is often permanent. But there are ways to manage hearing problems effectively during and after cancer treatment.

Tips for managing hearing problems

  • Avoid alcohol, tobacco products, and caffeine, which can increase the severity of tinnitus.

  • Stay hydrated as dehydration can worsen tinnitus.

  • Ask friends, family members, and co-workers to speak clearly to you but not to shout. Shouting can make it harder to hear or harm your ears.

  • Practice relaxation techniques and get lots of sleep. Stress and fatigue can worsen tinnitus.

  • Control your blood pressure, as high blood pressure can impair your hearing.

  • Ask your doctor about medications that can help manage nausea or dizziness, if needed.

  • Protect your ears from loud noises, which can worsen drug-related hearing problems.

Devices that can help manage hearing problems

  • Hearing aids. These small devices, worn in or behind the ear, make sounds louder. Hearing aids can also make tinnitus less noticeable when the background noise level is increased. 

  • Sound generators. Worn on the ear, these devices mask the sounds caused by tinnitus with other sounds more tolerable to the patient. A sound generator can be combined with a hearing aid.  

  • Environmental enrichment devices. These devices also mask sounds caused by tinnitus, but they are not inserted into or on the ear. Examples include tabletop “white noise” machines or apps that play music or nature sounds.

  • Auditory trainers. This device, often used in classrooms, includes a student-worn receiver and a small microphone worn by the speaker to transfer and increase the speaker's voice.

  • Cochlear implants. This surgically implanted electronic medical device replaces the function of a damaged inner ear, providing a sense of sound for people with profound hearing loss.

Watching for hearing problems after treatment

If you have had cancer treatment that can increase the risk of hearing loss, you should have your hearing tested at least once after treatment ends. Your health care team may recommend more frequent testing. How often you need testing depends on the type of cancer treatment you received.

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