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.

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.

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.

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

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:

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.

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