Cancer treatments have many uncertainties and side effects, both physically and emotionally. Whilst the focus of both medical specialists and the cancer patient should remain on the immediate threat to their health and achieving the most favourable outcome, hearing loss is one of the most common adverse effects of cancer treatments and as such shouldn’t be disregarded. We will discuss different types and causes of hearing problems and solutions to help with hearing loss.
Treatment options for cancer patients vary depending on the type of cancer and how advanced it is. The treatment approach will often combine different types of treatments such as surgery, chemotherapy and radiation therapy. Each treatment option has potential side effects, some mild and some severe, some immediate. Others do not become apparent until years after treatment is finalised.
Some of the side effects can affect the auditory system resulting in tinnitus (the perception of noise in the ears in the absence of an external sound source) and hearing loss.
Tumours of the ear or temporal bone can damage hearing depending on their precise location. In addition, surgery to remove these tumours can also result in damage to the hair cells or auditory nerve, resulting in hearing loss.
Radiotherapy kills cancer cells and reduces the size of tumours using high dose radiation which damages the DNA inside the cancer cells. It may be used to cure cancer or prevent or slow the growth. The radiation can be delivered externally or internally depending on the type of cancer and is often used in combination with surgery.
Radiation is effective in damaging the cancer cells as intended, however, it also damages healthy cells. When the radiation is delivered to the ear or brain, the inner hair cells can be damaged causing a sensorineural hearing loss.
Different chemotherapy drugs are used to treat different cancers. Some are known to be ototoxic, meaning they damage the organs of balance and hearing (cochlea and auditory nerve), preventing them from functioning normally.
A well-known ototoxic drug is cisplatin, which has been used for many years to treat certain cancers. Other platinum-based drugs such as Carboplatin damage inner hair cells in the same way. In addition to chemotherapy drugs, other drugs that are sometimes needed in cancer treatment can also be ototoxic including certain antibiotics and anti-nausea medications.
Cisplatin is a drug that is highly effective when treating certain cancers, and as such will continue to be used despite side effects such as hearing loss. While treatment with cisplatin carries an extremely high risk of causing hearing loss, the effects of ototoxic medication depend on a number of factors including an individual’s susceptibility to the drug, the particular drug and the accumulation of the drug in the organ.
The risk of hearing loss increases as the concentration of the drug increases. Additional factors have also been associated with increased risk of hearing loss including noise exposure, fever, sensorineural hearing loss, heredity, prolonged and prior exposure to ototoxic drugs.
Research is currently being conducted to investigate exactly how and where the damage is occurring, in an attempt to prevent or limit the resulting hearing loss. This includes the recent finding that the cochlear retains the cisplatin for up to 18 months after the treatment has ceased.
This is particularly true of children and can have significant effects on speech and learning in children and socialisation and mental well-being in all who have been treated with the drug. Researchers hope to find a solution that allows cancer sufferers to continue to be treated successfully with cisplatin, but also to have their hearing preserved.
Certain antibiotics can cause hearing loss. Check-in with your GP and pharmacist to rule out that your medication could increase your risk for hearing loss and tinnitus.
Cancer survivors have already overcome many hurdles and have had their lives changed dramatically. Once the treatment has finished, they are looking to get their lives back, away from the regime of treatments and all the challenges that accompany it. However, life after cancer often looks very different.
A person’s perspective of life often changes, and they can be intent on making every moment count. However often they also face a difficult time as they confront fears and cope with the side effects of cancer treatment which may not show until years after treatment stops.
Hearing loss is a manageable condition however left untreated it can have a significant and negative effect on the quality of life, potentially resulting in uncertainty, anxiety, embarrassment and social isolation.
Your GP and audiologist may suggest the following solutions:
The earlier hearing loss is identified, the earlier it can be treated and its effects minimised.
Ideally, a hearing test should be conducted prior to the beginning of a cancer treatment so that a baseline hearing test or audiogram can be established. In the case of ototoxicity, the very high frequencies of a person’s hearing are affected first, and in instances of prolonged exposure, the lower frequencies may be affected later.
Have you been diagnosed with hearing loss? Here is a guide to looking after your hearing health!
Treatment-related hearing loss is not always immediate and sometimes does not become noticeable until years after. It is therefore advisable to have an annual hearing test to monitor hearing thresholds and discuss options as advised.
An initial assessment with your audiologist can determine the degree and nature of the hearing loss and identify whether devices such as hearing aids or assistive listening devices would be beneficial. Your audiologist will also help to develop communication strategies to be used by the survivor and their primary communication partners at home and in challenging listening situations in order to make them feel comfortable and connected.
Hearing loss can be frustrating for everyone and can be seen as yet another challenge for every cancer survivor to face. However, with the right information, support and communication tactics on hand, you will feel confident about managing your hearing loss!
For more information about hearing loss in cancer patients and possible treatment options,
or to make an appointment with a local Attune Hearing clinic, book online or give us a call!