Physicians are well aware of the many side effects of chemotherapy and radiation treatment. However, only in recent years has research addressed the risk of hearing loss and related symptoms (e.g. tinnitus/ringing in the ears) as reported by numerous post-cancer treatment patients. These studies have revealed a strong link between hearing loss and cancer treatments, especially among certain chemotherapy medications and radiation treatment.
It is critical for both physician and patient to understand the risk of ototoxicity (literally “ear poisoning’) when treating cancer, and its long-term implications, which may include permanent damage to the inner ear resulting in sensorineural hearing loss. Certain chemotherapy medications or radiation therapy can cause ototoxicity, which may result in either a temporary or permanent hearing loss, depending on the type, duration of cancer treatment and the extent of hearing damage.
Ototoxicity resulting in sensorineural hearing loss (permanent inner ear damage) refers to drug or chemical damage to the inner ear cochlear hair cells which are tuned to respond to different frequencies of sound. In addition, vital balance organs of the inner ear could be damaged. Thus, hearing loss, tinnitus and loss of balance are most commonly reported after effects of chemotherapy and radiation treatment in adults. However, hearing loss, tinnitus and loss of balance following the cancer treatment are underreported in children.
Platinum-based chemotherapy medications, particularly cisplatin and carboplatin are considered primary “culprints” when it comes to ototoxicity. Other potentially ototoxic chemotherapy drugs include Bromocriptine, Bleomycin, Vincristine, Vinblastin, and Methotrexate Nitrogen Mustard.
Chemotherapy from the “plantinum” group is commonly used to treat brain, head and neck cancers, as well as lung, bladder, and ovarian cancers in adults. It is also frequently used to treat brain, bone and liver cancers in children.
The effects of untreated hearing loss in adults include increased potential for falls, depression, cognitive decline, dementia and other psychological disorders. In addition, economic impact of untreated hearing loss includes higher rate of unemployment, difficulty retaining a job or advancing career.
The after effects of untreated hearing loss in children goes underreported. One landmark study of 67 patients age 8 to 23 undergoing chemotherapy found 61% developed hearing loss after treatment-most experiencing high-frequency hearing loss (HFHL). Many research studies have reported that HFHL in children primarily affects speech comprehension, yet children may not realize they are not interpreting speech properly and so the condition goes underreported and undiagnosed.
Consequences of untreated hearing loss in children could include significant delay in speech and language development, cognitive & psychosocial development, and negative educational outcomes.
It is crucial to involve an audiologist during and after cancer treatment to help monitor the effects of exposure to ototoxic cancer treatment.
As cancer treatments have more success and cancer patients live longer, early detection of hearing loss and hearing treatment plan such as hearing instrument amplification, counseling and aural rehabilitation are critical to improve patient’s quality of life after cancer treatment.
Dr. T.K. Parthasarathy, Ph.D., FAAA, former Professor of Audiology at SIUE with 30 years of experience in helping patients with hearing loss. He is an ASHA Certified Clinical Audiologist with 3 offices at the Better Hearing Clinic (www.betterhearingclinic.com) in Alton Memorial Hospital (618-433-7961), Edwardsville, and Glen Carbon (1-866-696-5958). As a part the Hearing Wellness Program in the community, all patients 50 years and older are eligible for a complimentary free hearing consultation.
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