Hearing problems (ototoxicity)

The ears are made up of three parts – the outer, middle and inner ear. Between the outer and middle ear is the eardrum. Sound makes vibrations in the air that enter the outer ear, pass through the eardrum and middle ear and finally reach the inner ear. The inner ear connects to the brain by the hearing nerve (auditory nerve). When the sound vibrations reach the hearing nerve, it sends a signal to the brain. The brain then turns the vibrations into sound that we usually recognise.

Damage to the ears can cause a number of hearing problems, including different levels of deafness or a whistling noise or ringing in the ear (tinnitus).

There are a number of things everyone can do to lower the risk of hearing problems, such as wearing ear defenders in very loud environments.

Am I at higher risk of hearing problems?

Anyone, including people who have never had cancer treatment, may develop hearing problems. However, there are some cancer treatments that may increase the risk of having hearing problems later in life. The problems that can occur depend on the type and dose of cancer treatment received.

The following treatments can increase the risk of hearing problems:

  • Chemotherapy with cisplatin can damage the inner ear. Any dose of cisplatin can cause hearing loss.
  • High doses of carboplatin (1500 mg/m2 or more) given together with cisplatin can damage the inner ear.
  • High doses of radiotherapy to the head or brain (30 Gy or more) can damage the middle ear or the hearing nerve.

You can find out if you have received any of these treatments by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.

If you experience hearing problems, it does not always mean that they are caused by your cancer treatment. Hearing problems may have other causes, such as long exposure to (extremely) loud noise or infection.

What are the symptoms and signs of hearing problems?

There are symptoms and signs that can tell you if you might have hearing problems. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.

These symptoms may suggest that you have hearing problems:

  • You find it difficult to hear everything clearly. When people speak to you, you often have to ask if they can repeat what they said.
  • You find it difficult to hear everything clearly when there is a lot of noise (for example at a birthday party or in a busy store).
  • You have difficulty hearing high-pitched noises, such as a ringing telephone or police siren.
  • You always, or very often, hear a whistling or ringing noise in your ears.

These symptoms and signs may suggest that your child has hearing problems:

  • Your child is slower at learning and speaking new words or sentences than other children of the same age.
  • When you make a sound, your child does not respond.
  • Your child has difficulty interacting with other children and/or learning at school.
  • When someone speaks, your child does not pay attention to them or does not understand what they are saying.
  • When watching television, your child often turns up the volume.
  • When someone speaks, your child often asks them to repeat themselves.

If you recognise any of these symptoms or signs in yourself or in your child, please contact a general practitioner or follow-up care specialist.

I am at higher risk of hearing problems. What tests should I have and when?

If you are at higher risk of hearing problems, it is advised to have a hearing test (audiogram) regularly after the end of cancer treatment.

The advised interval of testing depends on your or your child’s age:

  • Young children (0-5 years): Once a year
  • Older children (6-12 years): Every 2 years
  • Teenagers and adults (13 years and older): Every 5 years

For children younger than 6 years of age more specialised tests may be needed.

What happens if I have hearing problems?

If you have hearing problems, your general practitioner or follow-up care specialist will probably refer you to a specialist. Depending on the symptoms and/or signs you experience, you may be referred to an:

  • Audiologist (healthcare professional specialties in hearing)
  • Ear, Nose and Throat (ENT) specialist

The specialist may discuss different options with you, such as the support available, which may include hearing aids.

What else can I do?

Knowing that you may be at increased risk of hearing problems can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.

Although it may not influence your risk of hearing problems, it is still very important to live a healthy lifestyle. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.

Damage to the ears can often not be undone (it is not reversible). However, it is important to prevent further damage to the ears by avoiding loud noises or by wearing ear defenders (for example, at concerts or parties).

Additionally, if you or your child has a hearing problem, you may wish to inform the school, college, university or work place.

It is important that you are aware of the possibility of developing hearing problems and that you know the symptoms and signs. It is of particular importance to recognise and act upon this in very young children. They can then receive help with hearing early and develop their speech and language normally. If you have any further questions or if the information in this brochure concerns you, please contact your general practitioner or follow-up care specialist.

Where can I find more information?

You may find more information about hearing problems online. However, it is important to be aware that this information is not always up to date or accurate.

Some sources of further information are:

  • Cleveland Clinic: Here you can find more information about Ototoxicity in general
  • ACS journals: Here you can find more information about Ototoxicity and cancer treatment

On this website, you can also find more information related to this topic:

Please note

This information is based on the PanCareFollowUp guideline about “Ototoxicity” [1], which is itself based on the corresponding IGHG* guideline [2].

While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.

Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.

*International Guideline Harmonization Group for Late Effects of Childhood Cancer

[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: https://www.ejcancer.com/article/S0959-8049(21)00368-3/fulltext.

[2] Clemens, E. et al. (2019) 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. Available at: https://www.sciencedirect.com/science/article/abs/pii/S1470204518308581?via%3Dihub.