Permanent Hearing Loss May Occur Immediately After Chemo, Expert Says

After receiving cisplatin-based chemotherapy, it is essential for patients and survivors to maintain their hearing ability by reducing their exposure to loud noises and obtaining hearing aids when needed, an expert told CURE®.

Permanent hearing loss is associated with cisplatin-based chemotherapy, a study published in JAMA Network found. Importantly, hearing impairment “starts right away,” after receiving the treatment, study author Robert Frisina told CURE® via an email interview.

“Cisplatin is a highly reactive metal that kills cells,” Frisina said. “Not only cancer cells [are killed], but the sensory cells in the inner ear used for hearing and balance [are killed, too].”

Frisina is a distinguished university professor and department chair for the Department of Medical Engineering at the University of South Florida.

In the study, 100 testicular cancer survivors who had been treated with cisplatin-based chemotherapy were included. The median age was 48 years old, with a range from 26 to 67 years old. Of note, the median time since survivors received cisplatin-based chemotherapy was 14 years, with a range of four to 31 years.

At follow-up, 78 testicular cancer survivors had hearing loss, according to the study authors. Hearing loss was determined by audiometry, an instrument used to test the loudness (intensity) and the speed of sound wave vibrations (frequency).

Of the 78 survivors who experienced hearing loss, the study authors noted that survivors who self-reported hearing loss had two-fold worse hearing than survivors who did not self-report their hearing loss.

The study authors also reported that a higher percentage of testicular cancer survivors with hearing loss also experienced hypertension (high blood pressure; 20 survivors), hypercholesterolemia (high cholesterol in the blood; 25 survivors) and tinnitus (hearing sounds without an external source; 43 survivors).

An assessment, Words in Noise Test (WIN), was also used to determine whether survivors could accurately identify what words were spoken and the volume at which they could hear the spoken voice. The authors found that factors that may have affected WIN performance included hypercholesterolemia, education level and greater audiometrically-measured hearing loss. They noted that these three factors were independently, yet significantly associated with survivors’ poorer WIN performance.

Hearing Loss Exposures and Preventing Further Damage

Several exposures may also affect hearing loss in survivors who received cisplatin-based chemotherapy, Frisina noted.

“The greater the amount and the duration of cisplatin and the amount of noise exposure can increase the magnitude of the hearing loss after cisplatin chemotherapy,” he said. “Genetics and age also play a role.”

Frisina explained that researchers still need to study the “nature and time course of cisplatin-induced hearing loss” to potentially develop drugs that can neutralize hearing loss. But for now, he advised survivors to “avoid any additional loud noises.”

“[Survivors should] avoid additional loud noises [by] using earplugs in noisy environments, as well as practicing healthy aging lifestyles. For example, not smoking and exercising, can help,” Frisina said.

To further prevent permanent hearing loss, Frisina noted that survivors should have their hearing checked regularly. By doing so, they “can practice hearing loss prevention measures and obtain hearing aids when needed.

“It’s important [for survivors to] take care of the hearing that they have left and obtain hearing aids [to] help ensure good communication and prevent social isolation,” Frisina explained.

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