Hearing Problems After Childhood Cancer

Childhood cancer survivors may have hearing problems because of cancer or its treatment. Hearing problems include hearing loss and tinnitus (ringing or other sounds in the ears). They can affect 1 ear or both ears.  

Regular hearing checks can help find problems early. This makes it easier to get support at home, school, or work. 

If you think you have a hearing problem, tell your health care provider. You may need to see an audiologist (hearing specialist) or an otologist (ear doctor). 

How the ear works

The ear is made up of 3 parts: 

• Outer ear: The part of the ear you can see outside the body. It gathers sound and sends it through the ear canal to the eardrum. Sound waves make the eardrum vibrate. The outer ear also helps you tell where sounds are coming from. 
• Middle ear: Contains 3 tiny bones called ossicles that connect the eardrum to the inner ear. The vibrations from the eardrum move to the ossicles. The ossicles help make the sound louder and carry it to the inner ear. 
• Inner ear: Called the cochlea. It is filled with fluid and lined with thousands of hair cells. Each hair cell is sensitive to certain types of sound, like high and low pitches. When sound makes the fluid move, the hair cells send signals to the brain so you can hear.  

Types of hearing problems after childhood cancer

Hearing loss

Hearing loss means you cannot hear as well as you used to. It can be mild or more severe. It may happen during treatment or later. If you have hearing loss, you may: 

• Have a hard time hearing, especially with background noise 
• Turn the TV or radio up very high 
• Have trouble talking on the phone 
• Not notice sounds (like voices or traffic) 
• Have speech problems or changes 
• Have trouble at school or work 

Types of hearing loss include:  

• Conductive hearing loss: Occurs in the outer or middle ear  
• Mixed hearing loss: A combination of conductive and sensorineural  
• Neural hearing loss: Results from damage to the auditory nerve. It is usually severe and permanent. 
• Sensorineural hearing loss: Results from damage in the inner ear 

Learn more about Hearing Loss. 

Tinnitus 

Tinnitus means you hear a sound when it is quiet. The sound is not caused by something around you. It may come and go or last a long time. It can be soft or loud. 

Tinnitus may sound like: 

• Ringing 
• Buzzing 
• Hissing 
• Whooshing 
• Pulsing 

Symptoms depend upon the type of tinnitus. These may include: 

• Tonal tinnitus: Hearing a steady sound without an external source, such as ringing or buzzing. The loudness may change over time. This is the most common form of tinnitus. 
• Pulsatile tinnitus: Hearing rhythmic sounds that pulse or beat, often in time with the heartbeat. This type of tinnitus is rare and can be caused by changes in blood flow or high blood pressure. 
• Musical tinnitus: Hearing music or singing without an external source, sometimes the same tune repeating. This type is also rare and is sometimes called musical hallucinations or auditory imagery. 

Causes of hearing problems after childhood cancer 

Chemotherapy

Some chemotherapy medicines can damage tiny cells in the inner ear that help you hear. When these cells are damaged, it is harder for sound signals to reach the brain. This can lead to hearing loss.  

Platinum-based medicines such as cisplatin and high-dose carboplatin can cause hearing loss. 

Other medicines

Other medicines that may cause hearing loss include: 

• Some antibiotics, such as aminoglycosides (amikacin, gentamicin, tobramycin) and erythromycin
• Some water pills (diuretics), such as furosemide or ethacrynic acid 

Radiation

Radiation to the ear or brain can harm hearing, especially at higher doses. It can cause: 

• Swelling or earwax buildup in the outer ear 
• Fluid buildup in the middle ear 
• Stiffness of the eardrum or middle ear bones 
• Sensory hair cell damage in the inner ear 

Surgery

Surgery on the ear or parts of the brain that help with hearing can sometimes affect hearing. 

Other risk factors for hearing problems

Other things that can affect hearing include: 

• Tumors that affect the ear, brain, or hearing nerves 
• Repeated ear infections or certain viral infections   
• Differences in how the ear is shaped  
• Head trauma or brain injury 
• Allergies 
• Aging 
• Being around loud noises for a long time 

Understanding your risk of hearing problems

What survivors can do

The risk of hearing problems can vary from person to person. Your risk may be higher if you: 

• Got certain chemotherapy medicines, especially cisplatin or high doses of carboplatin 
• Had radiation to the head or brain, especially at higher doses. Your risk depends on: 
  • How much of the hearing area was included in the radiation 
  • The total radiation dose  
  • How the radiation was given over time 
• Were young during treatment (especially under age 5 years) 
• Had chemotherapy and radiation at the same time 

To learn more about your risk of hearing problems: 

• Ask your care team which treatments you had and if you are at risk for hearing problems. 
• Share your survivorship care plan with your primary care physician (your main doctor).  
• Tell your care provider right away if you notice hearing changes or ringing. 

Screening for hearing problems after childhood cancer

An ear exam should be part of your regular checkups. Your provider will use an otoscope to look inside your ear. This helps them check for signs of infection, fluid, or earwax that could affect hearing loss. 

Hearing tests

If you are at higher risk for hearing problems, regular hearing tests can help find changes early. Talk to your health care provider about what tests you may need and how often. Some people need hearing tests for many years after cancer treatment ends.

How often you need tests depends on your age, treatment history, and past hearing test results. General guidelines are:

• Early childhood (under age 6): Every year
• Later childhood (ages 6–12): Every 2 years 
• Teens and adults: About every 5 years

Some people need tests more often. If you have hearing loss, you should get a hearing test every year or more often if recommended by your care team.

Types of hearing tests

The most common hearing test is an audiogram. During this test, you wear headphones and listen for sounds. You respond when you hear them.

If someone cannot do this test (for example, very young children or people who cannot follow the steps), the care team may use other types of hearing tests.

Other hearing tests may include:

• Speech audiometry: Checks how well you hear words and sentences
• Tympanometry: Checks how well the middle ear and eardrum move

Support for hearing problems

Regular follow‑up care is important for managing hearing loss after cancer treatment. Hearing can change over time. Ongoing care helps make sure you have the right support as your needs change.

Audiologists and otologists

Most follow‑up care for hearing loss is led by audiologists and otologists:

• An audiologist checks hearing over time. They help decide if hearing aids or other devices may help. They also help adjust devices and show you how to use them.
• An otologist who looks for medical causes of hearing loss. The otologist helps decide if treatments like hearing aids or cochlear implants may help.

These specialists work together to recommend the best tools and next steps to support:

• Hearing
• Communication
• School
• Work
• Daily activities

 You may need follow-up visits to help you manage a hearing problem. 

Speech and language therapy

If you have hearing loss, you may benefit from speech and language therapy. This therapy can help your child if hearing loss affects how they speak or how they understand others. 

A speech‑language pathologist (SLP) can teach your child ways to improve speech, listening, and communication skills. They may also suggest tools or strategies to help your child at home, school, or work.

School support: Kindergarten through grade 12

If your child is in grades K–12, ask your treatment center if they have a school liaison or academic coordinator. This person can help you work with your child’s school and set up support.

The academic coordinator can:

• Help teachers understand how treatment can affect learning
• Work with your care team to share helpful recommendations with the school
• Help set up school supports, like an IEP or 504 plan. Supports may include special listening devices, note-taking help, or sitting closer to the teacher.

School support: College or trade school  

For classroom accommodations in college or trade school, contact the student disability office. The Americans with Disabilities Act (ADA) says schools must give equal access to students with disabilities. A parent, caregiver, or school liaison can help you ask for the support you need.

You may also need to talk with each instructor about what helps you in class. It helps them to know what you need.

Support at work

If you are employed, talk to your manager or your employer’s human resources office about workplace accommodations. If hearing loss makes it hard to talk with others or manage daily activities, it may be a disability under the Americans with Disabilities Act (ADA). 

The ADA can help protect your rights at work. Employers may need to make changes to help you do your job, unless those changes are too difficult for the workplace to make. These changes could include:

• Hearing devices
• Visual signals
• Changes to your workspace

Employers can help protect hearing by:

• Reducing loud noise
• Providing hearing protection
• Teaching workers about noise safety.

Services and devices for hearing problems

Protecting hearing afer childhood cancer

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 that can damage them. Examples of items, activities, and jobs that can increase risk for hearing loss because of noise exposure include:

Tools and 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
• Taxi, 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.

Questions to ask your health care provider

• Am I at higher risk for hearing problems because of past cancer treatments?  
• What hearing tests or screenings do I need? How often should I have them?
• What hearing changes should I watch for?  
• If a test shows hearing loss or tinnitus, what are the next steps? 
• Do I need to see an audiologist or other specialist?
• What treatments or support might help with hearing problems?
• What can I do to protect my hearing day to day (noise protection, treating ear infections, managing earwax)?
• What should I tell others about my hearing loss?
• What support resources are available at work or school?

Find more information

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