Hearing Loss and Cancer: What’s Common, Why It Happens, and How It’s Managed

Hearing loss isn’t usually a sign of most cancers themselves, but it can happen due to cancers in or around the ear and is quite common as a side effect of cancer treatments like certain chemotherapies and radiation. ^{[1] [2]} In particular, tumors involving the ear can directly affect hearing, while drugs such as cisplatin can cause inner ear damage that leads to high‑frequency, sensorineural hearing loss. ^{[1] [3]}

When is hearing loss a “cancer symptom”?

• Ear or temporal bone tumors can cause hearing changes, tinnitus (ringing), drainage, pain, balance problems, or facial weakness depending on tumor location. ^[1]
• Vestibular schwannoma (acoustic neuroma), a benign tumor on the hearing/balance nerve, often presents with slowly progressive hearing decline, tinnitus, or dizziness; occasionally it can cause sudden hearing loss. ^[4]
• Most other cancers don’t directly cause hearing loss unless they involve ear structures or spread to that area. However, hearing loss is commonly linked to cancer treatments. ^[2]

Common treatment‑related causes

• Cisplatin and other platinum drugs: Frequently cause irreversible, bilateral, high‑frequency hearing loss and tinnitus; risk rises with higher cumulative doses and co‑exposures to other ototoxic drugs. ^[3] [PM22]
• Radiation to the head/neck: Can injure the cochlea and vestibular system, leading to hearing loss, tinnitus, and balance issues; risk exists even with modern techniques. [PM19]
• Combined cisplatin + radiation: Increases ototoxicity risk compared with either alone. [PM19] [PM22]
• Other medications used during cancer care (e.g., some antibiotics like aminoglycosides, loop diuretics) can add to ototoxic risk. ^{[3] [5]}
• General illnesses and high fever during treatment can also affect the inner ear. ^[6]

What does treatment‑related hearing loss look like?

• Typical pattern: Gradual onset, high‑frequency sensorineural loss with tinnitus; can progress to affect speech frequencies and everyday conversation. ^[3] [PM21]
• Timing: May appear during therapy or after completion; sometimes after the first dose in susceptible individuals. ^[3]
• Irreversibility: Tinnitus can be reversible, but hearing loss is often permanent once cochlear hair cells are damaged. ^{[7] [3]}

Who is at higher risk?

• Higher cumulative doses of cisplatin; concurrent ototoxic drugs; pre‑existing hearing problems; kidney dysfunction; extremes of age; and prior noise exposure can increase risk. ^[3] [PM22]
• Radiation dose to cochlear structures and combination therapy can raise risk. [PM19]

How is it detected and monitored?

• Baseline and serial audiometry during and after therapy help catch early changes and guide adjustments. ^{[5] [8]}
• Clinic assessments often include otoscopic exam and a battery of hearing tests performed by audiology teams experienced in cancer‑related ototoxicity. ^{[9] [2]}

Management and mitigation strategies

During cancer treatment

• Discuss regimen choices and dosing when ototoxic risk is high; consider dose modulation or alternatives when oncologically appropriate. [PM20]
• Avoid or minimize other ototoxic agents (e.g., aminoglycosides, loop diuretics) when possible. ^{[3] [5]}
• Hydration and renal protection during platinum therapy can help reduce overall toxicity risks. ^[10]
• Pediatric prevention: Sodium thiosulfate has been approved to reduce cisplatin‑induced hearing loss in children with certain localized solid tumors. [PM21]

Rehabilitation and long‑term support

• Hearing aids: Helpful for mild‑to‑moderate sensorineural loss; modern devices can be tailored to lifestyle and hearing profile. ^[11]
• Cochlear implants: Considered for severe or profound loss when hearing aids aren’t sufficient; these devices bypass damaged hair cells to stimulate the hearing nerve. ^[11]
• Specialist audiology care: Programs focused on cancer‑related hearing loss provide testing, counseling, and device fitting. ^[12]
• Balance therapy: For co‑existing vestibular issues after ear tumors or head/neck radiation. ^[13]

Practical tips for those in or after cancer treatment

• Report new ear symptoms early: Ringing, muffled hearing, fullness, pain, dizziness, or drainage warrant prompt evaluation. ^[1]
• Ask for baseline and follow‑up hearing tests if getting cisplatin or head/neck radiation; early detection allows potential treatment adjustments. ^[8] [PM22]
• Protect your ears: Limit loud noise exposure and avoid unnecessary ototoxic medications when alternatives exist. ^[5]
• Seek rehabilitation: Even if hearing loss is permanent, modern hearing devices and implants can significantly improve communication and quality of life. ^{[11] [12]}

Key takeaways

• Hearing loss is not a common sign of most cancers themselves, but ear‑region tumors can directly impair hearing. ^{[1] [4]}
• Hearing loss is common as a side effect of cancer treatments, especially cisplatin and head/neck radiation. ^[2] [PM22]
• Proactive monitoring and timely rehabilitation with audiology support, hearing aids, or cochlear implants can meaningfully improve day‑to‑day functioning and quality of life. ^{[9] [11] [12]}