Hearing Loss in People Living with Cancer
by Paul Gidley, MD
You’re a survivor. You’ve faced a cancer diagnosis, battled insurance companies, and endured hours of appointments. Now, after staring down the nausea and other common effects of treatment, you may notice that you’re having difficulty hearing. If you find yourself asking your friends to repeat themselves during conversation and think your hearing is not what it used to be, you may be right. Various cancer treatments can contribute to hearing loss in some people. But take heart – trained healthcare professionals can determine the cause of your hearing loss and even help to restore function.
Hearing loss in general is common and has many causes. Some people are born with partial or total hearing impairment. Normal aging can lead to loss of hearing function – more than 25 percent of people older than 65 and about 40 percent of those older than 75 have some degree of hearing loss. Some other causes are infection, noise, medication, and radiation therapy. In people with cancer, any or all of these factors may contribute to hearing loss.
Understanding the types of hearing loss can help to understand how cancer treatment may contribute to hearing impairment. The two types of hearing loss are conductive hearing loss and sensorineural hearing loss.
Conductive hearing loss prevents sound from traveling properly through the eardrum. Common examples of conductive hearing loss are wax buildup in the ear canal, a hole in the eardrum, or fl uid behind the eardrum. Most forms of conductive hearing loss can be corrected with medication or surgery.
Some chemotherapy agents that are effective against many types of cancer are known to produce hearing loss.
Sensorineural hearing loss refers to a problem with the inner ear or the nerve for hearing. Common forms of sensorineural hearing loss are hearing loss related to age, noise, and medications, including some forms of chemotherapy. Hearing impairment caused by medication is also known as ototoxicity.
Many medications can produce ototoxicity. For instance, a group of antibiotics known as aminoglycosides can impair hearing. Likewise, some chemotherapy agents that are effective against many types of cancer, such as cisplatin, are known to produce hearing loss. Radiation therapy near the ears can also produce hearing loss.
In people with cancer, hearing loss can have one or several different causes. Some people already have hearing loss before their cancer is diagnosed. For example, they may have noise-induced hearing loss from working around loud machinery, or they may have age-associated hearing loss. After the cancer is diagnosed, chemotherapy and/or radiation therapy may then cause ototoxicity. These factors all combine to produce more severe levels of hearing impairment.
If left untreated, hearing loss can affect social interaction and relationships. Those with impaired hearing may tire of asking to have words repeated. Others in their company may tire of having to repeat words. Households may become disrupted when a person with hearing loss requires the television volume too loud. The list of places where hearing loss becomes a problem is long and includes the home, workplace, church, restaurant, and theater.
Any person who has trouble understanding speech, who needs words repeated, or who requires loud television volume should express these complaints to his or her primary physician. The physician should examine the ears for an obvious cause of hearing loss, such as wax accumulation. If a problem with the ears is identified, the individual may be referred to an otolaryngologist (also called ENT or ear, nose, and throat physician) for further evaluation and treatment. Some people are sent directly to an audiologist, a professional who specializes in testing hearing. An audiogram, a picture of your hearing, is used to determine the type and degree of hearing loss and to help you and your physician decide on the appropriate form of treatment.
Hearing aids are very useful in helping people overcome their hearing loss. There are many different brands and sizes. Some hearing aids fit entirely within the ear canal. For people who require more power, a larger aid, such as one that fills the ear or that fits behind the ear, is required. Hearing aid technology has advanced tremendously over the last 10 years. These advances have helped to create hearing aids that provide excellent sound quality and that minimize problems such as background noise or feedback.
Cancer survivors should know that hearing loss is common and often treatable. Understanding the causes and the options available is the first step to restoring your hearing. Contact your physician and have your hearing checked. You’ll be glad you did.
♦ ♦ ♦ ♦ ♦
Dr. Paul Gidley is associate professor in the department of Head and Neck Surgery at The University of Texas M. D. Anderson Cancer Center in Houston, TX.
This article was originally published in Coping® with Cancer magazine, November/December 2008.