Can Immunotherapy Cause Hearing Loss, and How to Cope

Immunotherapy itself only rarely leads to hearing problems, but hearing loss and tinnitus are well‑known side effects of certain chemotherapies especially platinum drugs like cisplatin that are sometimes given together with immunotherapy. Hearing loss from platinum agents is typically dose‑related and may be irreversible, while tinnitus is more often reversible. ^[1] Hearing loss and tinnitus can occur due to inner‑ear damage during platinum‑based therapy, and risk can be higher in people with pre‑existing hearing issues. ^[2]

How Hearing Loss Happens During Cancer Care

• Platinum chemotherapy (e.g., cisplatin) can damage the inner ear (ototoxicity), leading to tinnitus and permanent high‑frequency hearing loss in some people. This effect is cumulative and related to total dose. ^[1]
• Ototoxicity risk is monitored in platinum‑based regimens; clinicians may recommend audiometry if symptoms develop. Caution is advised in those with prior ear problems or when taking other nephrotoxic drugs (like aminoglycosides), which can worsen ototoxicity. ^{[3] [4]}
• Ear tumors and certain head and neck treatments can also cause conductive or sensorineural hearing loss due to damage to the ear structures. Your care team may discuss hearing rehabilitation options if this occurs. ^[5]

Can Immune Checkpoint Inhibitors Affect Hearing?

Direct immune‑related hearing loss from checkpoint inhibitors appears uncommon compared with endocrine, skin, gut, or lung side effects. Most standard immunotherapy side effect lists focus on hormonal glands, fatigue, mood changes, and GI/skin issues rather than hearing. ^{[6] [7]}
That said, immune‑related inflammation can affect many organs; if an immune‑mediated inner ear inflammation were suspected, prompt evaluation and early treatment (often with corticosteroids) may be considered to prevent permanent damage. ^{[8] [9]}

Warning Signs to Act On

• Ringing or buzzing (tinnitus), especially new or worsening. This can precede measurable hearing changes. ^[10]
• Trouble hearing high‑pitched sounds, difficulty following conversations, or needing higher TV volume. These are typical early signs of ototoxicity. ^[10]
• Ear fullness, dizziness, or balance changes. These can suggest inner ear involvement and warrant assessment. ^[10]

What To Do If You Notice Symptoms

• Tell your oncology team right away. Early recognition allows dose adjustments, drug substitutions, or supportive measures. ^[4]
• Ask about audiology testing (baseline and follow‑up). Audiometry is recommended when symptoms arise during platinum therapy. ^{[3] [4]}
• Review your medication list. Avoid or minimize other ototoxic and nephrotoxic drugs (e.g., aminoglycosides) when possible to reduce risk. ^[3]

Coping and Protection Strategies

• Hearing conservation: Use ear protection in noisy environments and avoid loud headphone volumes. ^[10]
• Symptom management: Tinnitus can often be mitigated with sound therapy, relaxation techniques, and sleep hygiene. ^[10]
• Rehabilitation: Consider hearing aids or assistive listening devices if thresholds decline; these can improve communication and quality of life. ^[10]
• Care plan adjustments: Your team may modify chemotherapy dosing or schedule to limit further ototoxic exposure. ^[4]

When Steroids May Be Used

If an immune‑related inner ear inflammation is suspected (rare), corticosteroids are commonly used early to reduce inflammation and protect function, similar to other immune‑related adverse events management. ^{[8] [9]} While this approach is case‑specific, rapid treatment can be important to prevent permanent loss. ^[8]

Monitoring During Treatment

• Platinum‑inclusive regimens: Clinicians often monitor for ototoxic symptoms and may order audiometry if they develop. ^{[4] [3]}
• Immunotherapy: Routine labs focus on endocrine, metabolic, and organ monitoring, since those side effects are more common; hearing checks are symptom‑driven rather than universal. ^{[11] [12]}

Bottom Line

• Immunotherapy alone rarely causes hearing loss, but hearing problems are a recognized risk of platinum chemotherapies that may be combined with immunotherapy. ^{[1] [2]}
• Report any new tinnitus or hearing changes promptly so your team can intervene early with testing and treatment options to help protect your hearing. ^{[4] [3]}