Treatments used for many forms of cancer, as well as certain rare types of cancer that directly affect the ear(s), can affect your hearing. It’s important to understand the possibilities and know what to look for because, in some cases, early action can help. If you are affected by hearing loss, there are also resources that can help, including your care team at Dana-Farber.
What types of cancer can cause hearing changes?
Cancer that affects the ear directly is very rare. It can occur on the outside of the ear, usually caused by melanoma, a form of skin cancer. It can also occur inside and around the ear. These include:
- Brain tumors and brain metastasis that can affect the inner ear and auditory nerve and alter hearing.
- Other rare tumors.
What types of cancer therapy can cause hearing changes?
Chemotherapy, and radiation or surgery involving the ear or auditory nerve can all cause damage to the ear, called ototoxicity, that can affect hearing. Changes can include hearing loss (from mild to severe), tinnitus (ringing in the ears), or vertigo (a feeling of dizziness).
Patients with head and neck cancer often receive combinations of such therapies and, since radiation and surgery for these cancers involve areas near and around the ear, they may be at highest risk for hearing changes. However, many patients with other cancers, such as breast, gastrointestinal, gynecologic, or lung cancer, are also prescribed chemotherapies that can affect hearing.
At Dana-Farber, our care teams will work with you to make sure you understand the risks and benefits before beginning treatment.
What types of cancer medication can affect hearing?
Platinum chemotherapy, such as cisplatin and carboplatin, has the potential to affect hearing. The medicines can result in the production of toxic levels of chemicals called reactive oxygen species inside the ear. These chemicals can damage cochlear hair cells and other cells in the inner ear resulting in ototoxicity.
About half of all patients who receive platinum chemotherapy develop hearing-related side effects. Hearing loss from chemotherapy is often not severe enough to affect day-to-day activities. The damage, however, typically occurs in both ears and is permanent. Those at highest risk include:
- Children under 4 years of age who are still developing their ability to hear.
- Older adults who might already be experiencing hearing loss.
Certain antibiotics, pain medications, anti-nausea medicines, and over-the-counter medicines, such as aspirin, are also linked to hearing loss.
Can radiation therapy affect hearing?
Radiation to the brain, nose, sinuses, throat, or behind the cheekbones can affect hearing. For some cancers, radiation therapy could be curative and is needed to reduce the chance for a recurrence or progression of the cancer. Talk to your care team to understand the benefits as well as the risks.
The chance of hearing loss increases with higher doses of radiation and with the combination of radiation therapy and platinum chemotherapies.
Can I do anything to avoid hearing loss before or during treatment?
Prior to beginning treatment for cancer, ask your oncologist about hearing care. Suggestions might include:
- Before treatment begins: Visit an audiologist or ear, nose, and throat specialist (otologist). Getting a baseline measure of hearing and ear health can help your care team monitor and track changes that occur during treatment.
- During treatment: Schedule more frequent hearing tests. Frequent visits can help you identify changes and manage symptoms.
- After treatment: Continue to monitor hearing after treatment is over. Changes may continue to occur or worsen after treatment is complete, and monitoring will help you identify problems and manage them.
If you begin to experience hearing changes during treatment, alert your cancer care team immediately. A hearing evaluation by a specialized health care professional may be recommended.
What symptoms might indicate hearing changes?
Symptoms of changes to the ear include:
- Feeling lightheaded
- Nausea or vomiting
- Vertigo, feeling off balance or as if you are spinning
- Hearing sounds inside your ear
- Noticing that voices sound different or quieter
- Having trouble hearing when there is background noise
- Being unable to hear someone on the phone
- Needing to turn the TV or other device volume up
- Avoiding people because of hearing problems
What if hearing changes limit my activities and daily routine?
Talk to your care team about rehabilitation services that can help you adapt to hear changes. There are many devices that may help you adjust:
- For tinnitus: Devices such as white noise machines or apps that play music and nature sounds can help cover up sounds of tinnitus. Sound generators that come with hearing aids are also available.
- For hearing loss: Hearing aids and other devices such as auditory amplifiers can help make sounds louder or easier to hear.
- For severe hearing loss: Cochlear implants can help improve hearing for people with serious hearing loss. However, these devices are implanted into the inner ear and might not be appropriate for patients who need to be monitored using MRI scans as a part of follow-up for treatment for cancer that affects the head and neck.
Your state may also have helpful services. In Massachusetts, Assistive Technology Services and Independent Living Centers are valuable resources.
How can I cope with the emotional effects of changes to my hearing?
Cancer and cancer treatment are life-changing experiences. Changes such as a loss of hearing can be upsetting. Navigating the health system can also be challenging and coordinating day-to-day life can become more complex and even confusing.
If you need emotional support during or after treatment for cancer, social services can help. At Dana-Farber, the Adult Social Work Program can help you navigate services and line up support.
They also help with:
- Adjusting to the impacts of illness and treatment on functioning, coping, and relationships
- Coping with grief regarding illness related losses
- Problem solving to maintain independence and function
- Depression and anxiety
- Distress in response to diagnosis and treatment
- Concerns about drug and alcohol use
- Concerns about the impact of cancer on family and caregivers
- Discussing your illness and treatment with children
- Coping with advanced cancer and facing uncertainty
- Concerns about the impact of cancer on work, school, and finances
- Advance directives conversations and completion
- Finding support groups and connections