Welcome to

Together is a new resource for anyone affected by pediatric cancer - patients and their parents, family members, and friends.

Learn More

Hearing Problems in Childhood Cancer Survivors

Some childhood cancer survivors may experience hearing problems.

The most common conditions are hearing loss and tinnitus.

In some cases, hearing problems are temporary. In other cases, they are permanent. These conditions may happen in one or both ears.

Regular hearing evaluations after childhood cancer therapy are recommended.

If hearing loss is detected, it is important to be under the care of an audiologist or otologist, a doctor who specializes in hearing disorders. 

Hearing problems, especially in young children, may lead to other issues involving speech and language, social and emotional development, and school performance.

When talking about hearing problems, it is helpful to understand how the ear works.

The ear has 3 main parts:

  • Outer ear: Sound waves enter the ear through the outer ear. It acts like a funnel to direct sound through the auditory canal to the ear drum, which separates the outer and middle ear.
  • Middle ear: The middle ear is an air-filled chamber. Inside, 3 small bones called ossicles form a chain that connects the ear drum to the inner ear. These bones are named for their shapes: the malleus (hammer), the incus (anvil), and the stapes (stirrup). Sound waves cause vibrations that travel from the ear drum, to the bones of the middle ear, to the inner ear.
  • Inner ear: The inner ear consists of the fluid-filled cochlea. Thousands of tiny nerve endings, called sensory hair cells, line the cochlea. Hair cells change sound waves into nerve impulses. These signals travel along the auditory nerve to the brain. The brain processes the nerve signals and makes meaning of the sound.

What Types of Hearing Problems Can Occur?

Hearing problems start when 1 or more parts of the ear are damaged.

Hearing loss and tinnitus are the 2 main types of hearing problems in childhood cancer survivors.

Hearing Loss

The signs and symptoms of hearing loss include:

  • Difficulty hearing in the presence of background noises
  • Being unable to hear people on the phone
  • Needing the TV, radio, or other device volume turned up very high
  • Not paying attention to sounds (such as voices, environmental noises)
  • School problems associated with hearing, such as trouble hearing the teacher or the voices of other students.

There are different types of hearing loss.

  1. Sensorineural hearing loss occurs when something damages the inner ear. This type of damage is often permanent.

  2. Conductive hearing loss occurs when something blocks the outer ear or middle ear from reaching the inner ear. Sometimes it is something treatable such as earwax or an ear infection.

    Other times conductive hearing loss may occur because of stiffness and scarring of the ear drum or bones in the middle ear. This can prevent sound waves from reaching the inner ear and auditory nerve. Medical treatments may not be able to reverse this.

  3. Some types of hearing loss are a combination of both types. This is called mixed hearing loss.

  4. Neural hearing loss results from damage to the auditory nerve. It is usually severe and permanent.

Tinnitus

Tinnitus is the perception of sound when no external noise is present. It may be temporary or ongoing. Perceived sounds may be ringing, hissing, static, crickets, screeching, whooshing, roaring, pulsing, ocean waves, buzzing, dial tones, or music.

The American Tinnitus Association has playlist of the most common tinnitus sounds.

Symptoms depend upon the type of tinnitus. The following descriptions are from the American Tinnitus Association.

  • Tonal Tinnitus: The perception of near-continuous sound (or overlapping sounds) with well-defined frequencies. The volume of the tinnitus fluctuates. 
  • Pulsatile Tinnitus: The perception of pulsing sounds, often in-beat with the patient’s heartbeat.
  • Musical Tinnitus: The perception of music or singing, sometimes the same tune on a constant loop.

Causes of Hearing Problems

Chemotherapy

Platinum-based drugs such as cisplatin and carboplatin, if carboplatin is given in high doses, may cause hearing issues.

Carboplatin is often used to treat:

When chemotherapy causes hearing loss, it is usually because the drug has been absorbed into the fluid that surrounds hair cells.

It keeps the hair cells from working properly. They cannot send signals to the brain, making it harder to hear certain sounds.

Other Medicines

  • Aminoglycoside antibiotics (amikacin, gentamicin, tobramycin) or erythromycin — These drugs are used to treat infections.
  • Certain diuretics such as furosemide or ethacrynic acid — These drugs are used to treat edema.

Radiation

High doses of radiation (30 Gy or higher) to the head or brain.

It can cause damage to the:

  • Sensory hair cells in the inner ear — Damage from radiation may affect one or both ears, depending on the area of radiation treatment.
  • Area of the brain that changes sound into meaning — the nerves that transmit electronic signals between the hair cells and the brain.
  • Eardrum, bones in the middle ear, and the tube that equalizes air pressure in the ear (Eustachian tube)

Surgery

Surgery involving the brain, ear, or auditory (eighth cranial) nerve may have an impact on hearing.

Other Conditions

Other conditions that are not caused by cancer and its treatment may lead to hearing loss in survivors. These may include:

  • Benign ear tumors
  • Ears that are shaped differently than normal
  • Head trauma
  • Viruses
  • Allergies
  • Getting older
  • Being around a lot of loud noise

What Survivors Can Do

Ask your oncologist about your risks of developing late effects.

Inform your primary health care provider about your risks. Share a copy of your Survivorship Care Plan, which includes a treatment summary. The summary includes details about your cancer treatment and information about health problems that may occur because of treatment.

Tell your provider if you have experienced any difficulties hearing or if you are hearing sounds such as ringing or buzzing that are not caused by an outside source.

Screening Recommendations

Everyone who has had cancer treatment that can affect hearing should have their hearing tested:

  • Children younger than 6 — Every year
  • 6-11 years old — Every 2 years
  • 12 and older — Every 5 years

Types of Hearing Tests

Survivors who are 3 or older should be screened with a pure tone audiogram (hearing screening test.)

During an audiogram, the person wears earphones and listens for sounds of different pitches and degrees of loudness.

People who are not able to have an audiogram (such as those who are too young or who cannot understand the test instructions) can have their hearing tested using Auditory Brainstem Response (ABR). The person having this test is usually given medicine so they can go to sleep, and then their brainwave responses to various sounds are recorded.

Additional tests may be necessary. These may include speech audiometry and tympanometry tests.

  • Speech audiometry tests the person’s ability to hear single words and sentences.
  • Tympanometry tests the status of the middle ear and the movement of the eardrum in response to a puff of air.

When a Hearing Problem Is Found

When a hearing problem is suspected, survivors are encouraged to have a consultation with an audiologist or otologist.

Patients with hearing problems should have ongoing follow-up.

Speech and language therapy for patients with hearing loss may be necessary.

School Concerns

Survivors with hearing loss who are students in K-12, college, or trade schools are encouraged to contact an academic coordinator or school liaison at their treatment center. The coordinator can help work with the school and advocate for the student’s educational needs.

The academic coordinator can:

  • Ensure educators understand how treatment may affect learning and are aware of services and strategies that will enable survivors to be successful in learning
  • Collaborate with doctors, nurses, psychologists, rehabilitation specialists, social workers, and other care team members to understand each survivor’s needs and make recommendations to the school or college
  • Attend Individual Educational Plan (IEP), 504 Plan, or other meetings for additional support. These supports may include assistive listening devices, note-taking, and preferred seating.

Post-High School

After high school, survivors are responsible for arranging services on their own. College and trade school students are encouraged to contact their school’s student disability office. The Americans with Disabilities Act requires postsecondary schools and programs that receive federal funding to make programs accessible to qualified students with disabilities.

Students can start working with these offices after they are accepted to the institution. A parent and/or academic coordinator can help request services and advocate for accommodations.

Students may also need to talk with each instructor about their medical history and what they need in each classroom. It is important that survivors are knowledgeable about their needs.

Services and Devices for Hearing Loss

  1. Hearing aids make sounds louder. Several types are available, depending on the age and size of the person’s ear and the extent of hearing loss.

    • Most children younger than 12 wear a behind-the-ear model to allow for adjustments as the child grows.
    • Teenagers and adults may benefit from a smaller device that fits in the ear or in the ear canal.
  2. These devices are particularly useful in schools. They allow people to hear the speaker clearly, even in a noisy environment.

    The person speaking, usually the teacher, wears a microphone that transmits sound over FM radio waves directly to a receiver worn by the person with hearing loss. The FM trainer can be worn alone or attached to the hearing aid. Newer hearing aids have FM technology integrated into the hearing aid.

  3. Telecoils: These small copper coils are an option on most hearing aids and are built into cochlear implant processors. They improve hearing by using the magnetic signal from a regular telephone to represent sound.

    Audio streamers: These systems wirelessly connect hearing aids to TVs, MP3 players, computers, and Bluetooth-enabled phones and devices. Some are also compatible with FM systems. The signal from the connected device is sent wirelessly and directly to the hearing aids.

    Tinnitus maskers: People with severe ringing in the ears can benefit from these devices. They look like hearing aids but produce a low level of "white noise" to distract users from the ringing sounds.

    Telephone aids: These include telephone amplifiers and teletypewriters (TTYs – sometimes referred to as Telephone Devices for the Deaf or TDDs.)

    Specialized appliances: These include alarm clocks that vibrate and smoke detectors with flashing lights.

  4. These services are available in video and voice/text formats. The video relay service is internet-based. A person using sign language communicates through a video interpreter, who translates the signed language into voice or text. The voice/ text relay service allows a person using a teletypewriter to communicate through an operator, who then relays the message to the hearing person is spoken form.

  5. Cochlear implants are devices that stimulate the auditory nerve.

    They may be an option for people with profound hearing loss who are unable to benefit from hearing aids.

    These devices are surgically placed behind the ear and electrodes are threaded to the inner ear. A microphone and speech processor are then used to transmit sound to the electrodes, stimulating the auditory nerve and allowing sound perception by the brain.

    After a cochlear implant is installed, the recipient will have training to learn to recognize and interpret sounds.

  6. These methods include lip (speech) reading, sign language, and cued speech. Cued speech combines mouth movements with a system of hand movements to facilitate.

  7. The Americans with Disabilities Act guarantees people with hearing loss equal access to public events, spaces, and opportunities. This access may include text telephones and telephone amplifiers in public places, and assistive listening devices in theaters. Some theaters also offer special showings of newly released movies with captioning.

Protecting Hearing

If you have or are at risk for hearing loss, be sure to seek treatment right away if you have an ear infection, swimmer’s ear, or earwax blockage. Also, take care to protect your ears from loud noises, which can damage your ears.

Examples of items, activities, and jobs that can increase risk for hearing loss include:

Appliances

  • Power saws
  • Vacuum cleaners
  • Lawn mowers
  • Yard trimmers
  • Leaf blowers

Recreation

  • Hunting
  • Boating or water skiing
  • Motorcycling or four-wheeling
  • Headphones
  • Amplifiers
  • Music

Occupations

  • Firefighters
  • Construction workers
  • Farmers
  • Airport workers
  • Cab, truck, and bus drivers
  • Hair stylists
  • Musicians

If you can’t avoid exposure to loud noise, you should:

  • Wear hearing protectors, such as earplugs or earmuffs.
  • Limit periods of exposure to the noise by taking breaks and going to quieter areas when you can.
  • Be aware of the noise around you and make efforts to limit it.


Reviewed: December 2019