Hearing Problems

Some chemotherapy drugs may cause damage to your inner ear, particularly platinum-based chemotherapy drugs. Other drugs that you may be taking in conjunction with your treatment may also contribute to hearing loss. Damage to your inner ear may cause hearing loss, dizziness, and ringing in the ears. Although there are no drug treatments for this side effect, there are steps you can take to manage your symptoms.

What hearing problems can be caused by cancer treatment?

Some cancer treatments may cause damage to the inner ear, also called ototoxicity, resulting in temporary or permanent hearing loss, dizziness, and/or ringing in the ears (tinnitus). If you already have hearing loss, this damage may cause it to worsen.

Which chemotherapy drugs cause hearing problems?

The following chemotherapy drugs have been reported to cause hearing problems in 10 percent to 29 percent of patients:

• Platinol^® (cisplatin)
• Paraplatin^® (carboplatin)
• Mustargen^® (mechlorethamine)

There are many other drugs that may cause hearing problems in some people. Some of the common ones that cancer patients may be taking include:

• Aspirin (high-dose, long-term use)
• Aminoglycoside antibiotics: erythromycin, gentamycin, tobramycin, or streptomycin
• Antinausea medications: Phenergan^® (promethazine).
• Diuretics: Lasix^® (furosemide), Diamox^® (acetazolamide)
• Heart and blood pressure medications: Lopressor^® (metoprolol)
• Nonsteroidal antiinflammatory drugs (NSAIDs): ibuprofen, Aleve^® (naproxen sodium)

How do chemotherapy drugs cause hearing problems?

The platinum-based chemotherapy drugs are thought to cause ototoxicity by producing free radicals. Free radicals are unstable molecules, which are produced during many normal cellular processes that involve oxygen, such as burning fuel for energy. They are also formed from exposure to elements in the environment, such as radiation, tobacco smoke, and chemotherapy drugs. Free radicals are very reactive, meaning they interact with other atoms to regain a more balanced state. In this way, free radicals cause damage to cell walls, certain cell structures, and genetic material within the cells.

What are some symptoms of damage to your ears?

Ototoxicity may cause sounds to seem muffled. You may also experience ringing or abnormal sounds in the ears, a condition called tinnitus. Tinnitus can interfere with your ability to rest, concentrate, or sleep at night. As your ototoxicity becomes worse, the sounds become louder.

Because your inner ear is involved in your sense of balance, one of the signs of ototoxicity is dizziness. If your dizziness worsens, it may be accompanied with nausea and vomiting. Notify your doctor immediately if you have any of these symptoms. Depending on the symptoms you are experiencing, you may be referred to a neurologist, otolaryngologist, or an audiologist.

How are hearing problems treated?

If you have hearing loss, your doctor may recommend that you be fitted for a hearing aid. Although there are no drug treatments specifically for ototoxicity, there are drugs that may be prescribed by your doctor to treat the symptoms of ototoxicity. Examples of the most commonly used drugs include:

• Antivert^® (meclizine), Dramamine^® (dimenhydrinate), or Transderm-Scop^®
  (scopolamine patch)
  
• Compazine^® (prochlorperazine) and Phenergan^®
  (promethazine)

Preliminary research also suggests that ototoxicity caused by cisplatin may be ameliorated by melatonin and other antioxidants. Antioxidants are organic substances that protect cells from the damaging effects of free radicals.

What else can I do?

There are a number of things you can do to help manage your hearing problems.

• Avoid loud noises to prevent further damage.
• Drink plenty of water and other fluids (fruit juices, noncaffeinated sodas and coffee, and nonalcoholic beverages) to prevent dehydration, which may worsen your symptoms. Alcohol and caffeine should be avoided because they may cause dehydration, which may lead to dizziness.
• Avoid stress, anxiety, and fatigue, which may worsen your symptoms. You may also be prescribed an antianxiety drug.
• Use a quiet radio, television, or any low level sounds when you are trying to rest. The background sound may help you ignore the tinnitus and make it easier to sleep or rest.
• Change positions slowly to give your body an opportunity to adapt to the change. It may be best to lie down until the dizzy feeling passes.
  
• If your dizziness persists, your doctor may teach you or have a trained therapist teach you “vestibular exercises” to try to get rid of your dizziness.
  

Notify your doctor if you have any changes in the patterns of hearing problems that you are experiencing.