Modern medicine and technology have made treating cancer more possible than ever. However, even with more advanced and effective therapies, undergoing cancer treatment is not easy for patients or loved ones. Patients who use chemotherapy to treat cancer may experience a range of side effects, with some more serious and permanent than others. One such negative side effect is hearing loss after chemotherapy. Read on to learn why this occurs and how to monitor it.
Different types of chemotherapy can cause a variety of side effects in patients. Among chemotherapies, platinum-based chemotherapy side effects are most likely to involve sudden hearing loss as it is ototoxic—meaning it can damage your hearing health and lead to tinnitus, hearing loss and/or balance issues. The most common platinum-based chemotherapies (chemo medication that contains platinum) are cisplatin and carboplatin. The drug cisplatin is used to treat several types of cancer and is most widely known for treating testicular, cervical, ovarian and bladder cancers.
Certain kinds of drugs, including platinum-based chemotherapy, are ototoxic. Ototoxic medications don’t affect all patients in the same way and their effects on hearing health vary based on a person’s age, health history, the type of drug and the extent of exposure.
Cisplatin is highly ototoxic, and according to the National Cancer Institute, causes inner ear damage to at least 50% of children who use this medication and to 40% to 80% of adults who do. This damage to the cochlea and inner ear hair cells leads to severe and permanent hearing loss.
Radiation therapy, another form of cancer treatment that’s often used in conjunction with chemotherapy, can also cause hearing problems for patients. Radiation uses high-energy particles or waves to kill cancer cells and shrink tumors. Especially when used to treat head or neck cancers, radiation therapy may lead to damage of the cochlea or acoustic nerve, resulting in sensorineural hearing loss (SNHL).
Radiation therapy can also result in conductive hearing loss, or hearing loss due to issues in the outer or middle ear. This kind of treatment can cause the ear canal to narrow, the eardrum to thicken or the buildup of fluid in the middle ear.
A cancer diagnosis can mean making difficult decisions when it comes to your treatment plan. Life-saving treatments like platinum-based chemotherapy can have side effects detrimental to quality of life, such as hearing loss. It’s important to talk to your doctor about the potential risks and benefits of any treatment so you feel informed and confident about your plan.
If you begin treatment with an ototoxic medication, it’s important to continually monitor your hearing health and look for signs of hearing loss. Before starting treatment, schedule a hearing test to establish a baseline of your hearing and balance systems. During the course of treatment, it’s a good idea to schedule periodic hearing tests to stay on top of any changes to your hearing that may be happening slowly and subtly.
Be sure to look out for any noticeable changes to your hearing as well. Symptoms of early hearing loss include not being able to understand certain sounds, missing parts of conversations, trouble hearing in crowds and hearing ringing in your ears.
Nobody should have to choose between being cancer-free or maintaining their hearing. Although hearing loss after chemotherapy is permanent due to irreversible damage of the inner ear, hearing aids can help. At Miracle-Ear, we offer a variety of hearing aid types and styles, with a range of technologies and features, to help all patients find a hearing aid that meets their needs. If you’ve lost your hearing due to chemotherapy or another form of cancer treatment, visit your local Miracle-Ear center today and start your journey to better hearing.
Hearing loss is a known side effect of certain chemotherapy treatments, especially those that are ototoxic, meaning they can damage the inner ear. Among these, platinum-based chemotherapy drugs are the most strongly associated with hearing impairment.
The most well-documented ototoxic agent is cisplatin, which is widely used to treat various cancers. Cisplatin can cause permanent, high-frequency hearing loss and is particularly harmful to young children and older adults. The risk of hearing loss tends to increase with higher cumulative doses.
Carboplatin, another platinum-based drug, is generally considered less toxic to hearing than cisplatin, but it can still cause hearing changes in some patients, especially when given at high doses or in combination with other ototoxic medications. It may also lead to tinnitus (ringing in the ears).
Oxaliplatin, a third drug in this class, is rarely linked to hearing loss, though it is known to cause nerve-related side effects such as peripheral neuropathy. Hearing issues with oxaliplatin are uncommon but possible, particularly when combined with other treatments.
Outside of the platinum-based group, a few other chemotherapy drugs have been associated with hearing problems, though the evidence is less consistent. Vincristine, for instance, is more commonly linked to nerve damage, but in rare cases, it may affect the auditory nerve. Methotrexate, especially in high doses or when administered directly into the spinal fluid (intrathecally), has been linked to central auditory processing issues, particularly in children. There have also been occasional reports of hearing changes linked to 5-fluorouracil (5-FU), likely due to its vascular side effects.
Several factors can increase the risk or severity of chemotherapy-induced hearing loss. These include age (with very young children and older adults being more vulnerable), high cumulative doses of chemotherapy, the concurrent use of other ototoxic medications (such as certain antibiotics or diuretics), previous or simultaneous radiation therapy to the head or neck, and pre-existing hearing conditions.
To manage these risks, patients receiving potentially ototoxic chemotherapy—especially cisplatin—are often monitored with baseline and regular hearing tests during treatment. In some cases, healthcare providers may consider otoprotective agents, such as sodium thiosulfate, which are being researched and used to reduce the risk of hearing loss, particularly in children.
Chemotherapy involves the use of powerful drugs to destroy cancer cells, but some of these medications can also damage healthy tissue. Certain chemotherapy drugs are known to be ototoxic, meaning they can harm the inner ear and affect hearing.
This is particularly true of platinum-based chemotherapy, which includes drugs containing the metal platinum. Among these, cisplatin is considered the most ototoxic, as reported in a review published in Cancer Chemotherapy and Pharmacology.
According to the National Cancer Institute, cisplatin is commonly used in the treatment of bladder, testicular, and ovarian cancers in adults. It is also used in children to treat brain, liver, and bone tumors, as noted by St. Jude Children’s Research Hospital.
One of the most concerning side effects of cisplatin is permanent hearing loss, which can occur in up to 50% of patients, particularly affecting high-frequency sounds, according to the American Speech-Language-Hearing Association (ASHA). A 2024 study published in JAMA Oncology reported that nearly 80% of testicular cancer patients treated with cisplatin developed hearing loss. The risk was higher among patients who were older, received higher cumulative doses, or had elevated cholesterol levels.
In addition to hearing loss, cisplatin can cause a range of other side effects, including:
Due to these risks, patients receiving cisplatin typically undergo regular hearing tests, kidney function assessments, and blood work to monitor complications. Where possible, healthcare providers may adjust doses or use protective agents to minimize side effects.
Can chemotherapy affect hearing in younger patients? Yes, unfortunately hearing loss is a well-documented side effect of cisplatin, particularly in young children. A 2021 study from the University of British Columbia found that 75% of children aged five and under experienced hearing loss within three years of starting cisplatin treatment.
Children are especially vulnerable to the ototoxic effects of certain cancer therapies. As noted in a 2016 review published in the journal Cancer, this heightened sensitivity is because both the brain and auditory system are still developing during early childhood.
Not only is hearing loss more frequent in children treated with cisplatin, but it also tends to be more severe, according to the American Speech-Language-Hearing Association (ASHA). Even mild high-frequency hearing loss can significantly impact young children, particularly during critical stages of language development.
While research is ongoing, scientists believe that cisplatin enters the inner ear more readily than many other medications—yet it does not exit as efficiently. Once inside, it may damage the delicate hair cells in the cochlea, which are essential for detecting sound.
Other platinum-based chemotherapy drugs, such as carboplatin and oxaliplatin, are generally considered to be less ototoxic, though they are not without risk. For example, experts note that carboplatin can lead to tinnitus (ringing in the ears), even if it doesn’t typically cause the same degree of hearing loss as cisplatin.
While platinum-based chemotherapy drugs like cisplatin are most strongly associated with hearing loss, several non-platinum chemotherapies have also been linked to hearing problems and tinnitus. A 2016 study published in the Brazilian Journal of Otorhinolaryngology identified drugs such as vincristine, doxorubicin, gemcitabine, cyclophosphamide, oxaliplatin, and farmorubicin (also known as epirubicin) as having potential ototoxic effects. Though these drugs may carry a lower risk than cisplatin, they can still impact hearing—particularly when used at high doses or in combination with other treatments.
The risk of hearing damage increases significantly when radiation therapy—especially to the head or neck—is combined with these ototoxic chemotherapy agents. This combination can amplify the potential for inner ear or auditory nerve damage, raising the likelihood of hearing loss or persistent ringing in the ears (tinnitus).
It’s also important to recognize that not all ototoxic risks come from cancer drugs alone. Non-cancer medications commonly used during treatment—such as certain antibiotics, pain relievers, or anti-nausea drugs—can also contribute to hearing problems. In fact, more than 200 medications are known to be linked to hearing loss, including some over-the-counter drugs like aspirin when taken in high doses.
Because of the cumulative effects of these medications, cancer patients are often monitored for hearing changes throughout their treatment, especially when multiple ototoxic drugs are being used at once.
Hearing loss caused by chemotherapy can develop gradually and may be subtle at first. One of the most common warning signs is the onset of tinnitus, a persistent ringing in the ears. However, the most reliable way to determine whether your hearing has been affected is through a hearing test conducted by an audiologist.
It’s strongly recommended to have your hearing tested before starting chemotherapy to establish a baseline and then monitor it regularly during and after treatment. This helps detect any changes early and allows for informed decisions about your care.
Unfortunately, hearing tests are sometimes overlooked in the rush to begin cancer treatment. Patients and care teams may focus on the cancer itself, meaning that symptoms like hearing changes can go unnoticed or unreported. That’s why it’s important to talk with your oncologist or treating physician about how your hearing will be monitored throughout treatment.
If you experience any hearing changes—such as muffled sounds, difficulty understanding speech, or ringing in the ears—it’s important to inform your medical team immediately. Hearing loss related to chemotherapy is often permanent, so early detection is key.
Currently, there are few effective treatments for chemotherapy-induced hearing loss. In some cases, steroids may be prescribed in the early stages, although their benefit is not guaranteed. Because treatment options are limited, prevention and monitoring remain the most effective strategies.
In some situations, symptoms of hearing loss may prompt your healthcare team to adjust your chemotherapy regimen, depending on factors such as the type and stage of cancer and the availability of alternative treatments.
Cancer is a serious, life-threatening illness, which is why doctors often rely on aggressive treatments like chemotherapy—even when those treatments carry significant side effects, such as hearing loss. Understanding these risks in advance can help patients make informed decisions about their care and weigh whether the potential for hearing damage is acceptable given the benefits of the treatment.
If you're receiving or have received cancer therapy associated with hearing loss, regular hearing check-ups are essential—both during and after treatment. This is especially important for children and those treated with known ototoxic medications.
The American Speech-Language-Hearing Association (ASHA) recommends taking the following steps to protect your hearing:
In some cases, alternative cancer therapies may be available for individuals who are especially concerned about the risk of hearing loss or tinnitus. It's important to discuss the potential side effects of each treatment with your oncologist, along with any available options.
Researchers are also exploring the use of "otoprotective agents", medications designed to protect the ears from damage while chemotherapy is administered. According to Research Outreach, one promising example is sodium thiosulfate, which may reduce cisplatin-induced hearing loss in children. However, the challenge lies in ensuring that these protective medications don’t interfere with the cancer-fighting effectiveness of chemotherapy.
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