Side Effect: Difficulty Hearing

What is Difficulty Hearing?

Difficulty hearing, also known as hearing impairment or hearing loss, refers to any decrease of the ability to perceive sounds or understand speech. It can manifest in various ways, depending on the individual and severity of their hearing loss, ranging from mild to profound. In patients with cancer, hearing loss can pose additional challenges including communication difficulties with healthcare providers and family members, and reduced ability to participate in daily activities including work.

What does Difficulty Hearing look like?

While patients with difficulty hearing don’t necessarily look any different, they might frequently ask others to repeat themselves or appear to misunderstand conversations. They may rely heavily on visual cues, such as lip reading, which means they often focus on the speaker's mouth rather than making eye contact. Those with hearing challenges might avoid social settings due to the strain of trying to follow conversations, or they may exhibit signs of fatigue from constant effort to hear and understand. Some individuals might use hearing aids or cochlear implants, which can be discreet or visible depending on the device.

Who gets Difficulty Hearing?

Common causes of difficulty hearing include exposure to loud noises, aging, genetic factors, and certain medications. Hearing difficulties are a notable concern among patients with cancer, particularly those who undergo certain chemotherapy treatments. Ototoxicity, or hearing problems due to medicine, is a side effect of some chemotherapy medications. While any patient with cancer receiving these medications can be affected, the elderly and those with pre-existing hearing conditions are particularly vulnerable. Patients with cancers of the head and neck receiving radiation, with or without chemotherapy, are at an increased risk of hearing loss due to the location where the radiation is being given. The medications listed below can damage hair cells in the inner ear, leading to hearing loss:

Common chemotherapy medications that cause hearing loss:

• Cisplatin (Platinol®)
• Carboplatin (Paraplatin®)

Common antibiotics that cause hearing loss (also known as aminoglycosides):

• Gentamicin
• Amikacin
• Tobramycin
• Neomycin
• Streptomycin

How to prevent Difficulty Hearing

Preventing hearing difficulties in patients with cancer involves regular hearing assessments for patients on certain therapies (cisplatin, carboplatin) to monitor and manage any changes in auditory function during and after treatment. Minimizing exposure to these medications, when possible, can also help (examples: using lower doses or shorter treatment durations). Avoiding risk factors including loud noises and using ear plugs in noisy environments is another strategy. Additionally, antioxidant supplements like magnesium have also assisted in protecting patients from hearing loss.

How to treat Difficulty Hearing

Difficulty hearing in patients with cancer is treated involving a multifaceted approach tailored to the individual’s specific needs and the extent of their hearing loss. Some examples of treatment options are:

• Hearing aids
• Cochlear implants
• Surgery: insertion of tympanostomy tubes
• Discontinuation/adjusting chemotherapy medications (ex: cisplatin, carboplatin)
• Antioxidant supplements such as magnesium
• For the future: otoprotective agents like sodium thiosulfate, amifostine are being studied.

Early intervention and ongoing management by healthcare providers and audiologists are crucial in optimizing hearing outcomes for patients with cancer. Difficulty hearing is a problem that requires careful monitoring, and a range of treatment options are available to help.