Evidence-based recommendation for ear problems (IGHGa)

This page is part of the PanCare follow-up recommendations for surveillance of late effects. Click here, for more information on these recommendations.

Who is at risk for ear problems?

CAYA cancer survivors treated with

  • Cisplatin (with or without carboplatin > 1500 mg/m2)
  • Head or brain radiotherapy ≥ 30 Gy

What ear problems might occur?

  • Hearing loss
  • Tinnitus

What surveillance modality should be used and at what frequency should it be performed?

For survivors ≥6 years of age at risk:

  • Pure tone conventional audiometry testing at 1000–8000 Hz, and additional testing with high frequency audiometry at >8000 Hz (whenever equipment is available) every other year for children 6-12 years of age, and every 5 years for adolescents and young adults ≥12 years of age, to begin no later than the end of treatment

For survivors <6 years of age at risk:

  • Extensive testing by audiologist every year, to begin no later than the end of treatment

What should be done if abnormalities are identified?

  • Refer to audiologist or auditory clinic if there are symptoms suggesting hearing loss or abnormal audiological test results showing a loss of more than 15 dB absolute threshold level (1000–8000 Hz) or if there are symptoms of tinnitus


While PanCare strives to provide accurate and complete information that is up-to-date as of the date of publication, we acknowledge that the sequence of referral and diagnostic tests might vary according to the local and national healthcare system logistics.

It is recognised that survivors and their healthcare professionals have the final responsibility for making decisions concerning their long-term follow-up care. As such, they may choose to either adopt these recommendations or not to do so after individual informed discussion. It is good practice to document this decision.

In addition to regular surveillance, real-time awareness and prompt reporting of new symptoms and signs is essential to the early detection and timely treatment of late effects.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information.

The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.

a This recommendation reflects the content of the IGHG Ototoxicity guideline (Recommendations for ototoxicity surveillance for childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCare Consortium, Lancet Oncology, 2019; accessible through http://www.ighg.org/guidelines/topics/ototoxicity/).