Chemotherapy and Hearing Loss: Risks, Signs, and Coping Strategies

Chemotherapy can cause hearing changes, including tinnitus (ringing) and hearing loss, a side effect known as ototoxicity. This is most commonly linked to platinum-based drugs like cisplatin, and can affect high-frequency hearing and sometimes balance. ^{[1] [2]} Hearing loss may be unilateral or bilateral and often becomes more frequent with repeated doses, with children being at higher risk. ^{[1] [2]} In contrast, carboplatin has a lower ototoxic risk, but hearing loss has been reported, especially at high doses or when combined with other ototoxic medicines. ^[3]

What ototoxicity looks like

• Tinnitus (ringing, buzzing, hissing). ^[2]
• Difficulty hearing high-pitched sounds (4,000–8,000 Hz), which may progress to trouble hearing normal conversation. ^{[1] [2]}
• Balance issues (vestibular symptoms) in some cases. ^{[4] [2]}
• Onset during or after treatment; may occur even after the first dose of cisplatin. ^{[2] [5]}
• Risk increases with cumulative exposure and in pediatric populations. ^{[1] [4]}

Drugs most associated with hearing loss

• Cisplatin (highest risk): Up to 31% with a single 50 mg/m² dose; may be irreversible and can worsen with repeated dosing. ^{[1] [4]}
• Carboplatin (lower but present risk): Clinically significant hearing loss reported in children at higher-than-recommended doses and when combined with other ototoxic agents. ^[3]
• Drug combinations: Ototoxicity may be more severe when combined with nephrotoxic or ototoxic medications (e.g., aminoglycoside antibiotics). Avoiding or limiting such combinations reduces risk. ^{[6] [7]}

Monitoring and prevention

• Report new tinnitus, muffled hearing, or balance problems immediately; early action matters. ^{[6] [8]}
• Audiometry (hearing test) should be performed if symptoms develop, and may be considered at baseline for high‑risk regimens. ^{[6] [8]}
• Use platinum drugs with caution if you already have hearing issues or other risk factors. ^{[6] [9]}
• Review other medications (e.g., aminoglycosides) to limit additive ototoxicity. ^{[6] [7]}
• Hydration and kidney protection protocols are critical with cisplatin; although aimed at nephrotoxicity, they may indirectly help by reducing drug accumulation. ^{[7] [10]}

---

Practical coping strategies

Immediate steps

• Tell your oncology team right away if you notice ringing or hearing changes; dose adjustments or switching drugs may be considered depending on your cancer plan and symptom severity. ^{[8] [9]}
• Get formal audiology evaluation (hearing tests) to document changes and guide interventions. ^[6]

Communication tools

• Use simple hearing strategies: face the speaker, ensure good lighting, reduce background noise, and ask people to speak clearly and a bit slower (not louder). These adjustments can make conversation easier day‑to‑day. ^[11]

Assistive devices and rehabilitation

• Conventional hearing aids can amplify sound for sensorineural hearing loss caused by chemo. They are often the first-line device. ^[12]
• CROS hearing aids help if one ear is substantially worse by routing sound to the better ear. This can improve speech understanding in challenging environments. ^[12]
• Bone‑anchored hearing systems (minor surgery) transmit sound via bone conduction to the better ear without an in‑ear device. Useful for single‑sided deafness or conductive components. ^[13]
• Cochlear implants may be considered for severe to profound sensorineural loss when hearing aids are insufficient. These devices can restore access to sound and speech for many users. ^[13]
• Balance therapy can help if vestibular symptoms occur alongside hearing changes. Structured rehabilitation improves stability and reduces fall risk. ^[14]

Lifestyle and safety tips

• Protect your ears from loud noise (concerts, power tools); use ear protection to prevent additional damage. Noise plus ototoxic drugs can compound harm. ^[15]
• Prioritize sleep and stress management to reduce tinnitus perception.
• Use captioning apps and amplified phones for clearer communication.
• Inform family and coworkers so they can support with communication strategies.

---

When to seek urgent care

• Sudden hearing loss, severe vertigo, or rapidly worsening tinnitus warrant prompt medical attention, as early intervention can improve outcomes. Your oncology team can coordinate with audiology and ENT (ear, nose, and throat) specialists. ^{[6] [8]}

---

Summary table: Ototoxic chemo and management

Topic	Key Points
Main culprits	Cisplatin (highest risk); carboplatin (lower but possible, higher risk in children or with other ototoxins). [1] [3]
Typical symptoms	Tinnitus, high‑frequency hearing loss, possible balance issues; can start during or after treatment. [2] [4]
Risk factors	Cumulative dosing, pediatric age, concurrent aminoglycosides/ototoxins, pre‑existing hearing issues. [1] [6]
Monitoring	Report symptoms; audiometry if symptoms develop; consider baseline for high‑risk regimens. [6] [8]
Management	Dose adjustment/substitution when appropriate; hearing aids, CROS, bone‑anchored devices, cochlear implants; balance therapy. [12] [13] [14]
Prevention	Limit noise exposure; avoid additive ototoxic meds where possible; maintain hydration/kidney protection with cisplatin. [7] [15] [10]

---

Bottom line

Chemotherapy especially cisplatin can cause tinnitus and hearing loss that may be permanent, while carboplatin carries lower but real risk. Early recognition, prompt audiology testing, and tailored hearing solutions (from hearing aids to cochlear implants) can help you maintain communication and quality of life. ^{[1] [2]} Working closely with your oncology team to monitor symptoms and adjust treatment when safe is key. Combining medical management with practical communication strategies and assistive technology provides the best overall plan. ^{[6] [12] [13] [14]}