Kids, Chemo and Hearing Loss: What New Research Reveals

Julia Métraux

Health Writer

Cancer treatment is a difficult time for young patients and their families. Although chemotherapy has important advantages in the treatment and management of a variety of cancers, some negative side effects are worth consideration. Recent research indicates that children receiving chemotherapy treatment may develop a challenging, life-altering side effect: hearing loss.

What the research reveals

A February 2021 study published in The Lancet Child & Adolescent Health journal found that children receiving cisplatin, a common chemotherapy drug, may experience diminished hearing. Indeed, the study found that 44 percent of pediatric patients treated with the drug developed moderate to severe hearing loss.

The risk of cisplatin-induced hearing loss (CIHL) was greatest among children under age five. The lead author Etan Orgel, MD, MS, oncologist and researcher at Children’s Hospital Los Angeles, told Hearing Tracker that, “We think it's likely that there’s something about how the drug gets absorbed into the body and then crosses into the inner ear that's different in younger children than in adults or teenagers.”

The researchers also found a link between the dosage of cisplatin and the possibility of permanent hearing loss: The higher a child’s dose, the more likely they were to develop CIHL. The type of cancer that a child has does not impact the risk of developing hearing loss.  “It's the amount of the medication, how it's given to them, the combination of treatment, [and] the intensity of it that puts them at very, very high risk for hearing loss,” Dr. Orgel said.

A lifelong health issue

Unfortunately, children with CIHL may find that their hearing continues to decline after treatment. Dr. Orgel cautioned that following chemotherapy with cisplatin, a patient’s hearing loss may intensify due to triggers like loud music.

“When we're done with therapy, that's not the end of the battle. Even if you have hearing loss during therapy, it's often not where your hearing ends up years later,” Dr. Orgel said. “So, then we talk about hearing preservation.”

The ongoing impact of CIHL

Previous research on CIHL has shown just how devastating this issue can be for survivors of childhood cancer. A 2015 study published in the Cancer journal found that hearing loss from cisplatin may interfere with cancer survivors reaching certain key milestones. “Survivors of non‐CNS [meaning not of the central nervous system] solid tumors with serious hearing loss had nearly twice the odds of not graduating from high school and/or unemployment compared with those without serious hearing loss,” the researchers wrote. 

Consider also that children with sensorineural hearing loss may face worse mental-health outcomes. A 2019 study published in BMC Public Health found that sensorineural hearing loss can affect people’s mental health up to 43 years later. The researchers wrote that their findings “suggest that women with slight or mild sensorineural hearing loss from childhood experience elevated levels of anxiety and depression, lowered subjective well-being and lowered self-esteem.” 

Looking ahead

All this learning highlights the need for cancer treatments that do not increase the risk of hearing loss. The team responsible for the new research acknowledges that more studies and solutions are needed as soon as possible. “We want to make sure we're paying attention to the side effects of our therapies – and to balance curing cancer while preventing lifelong hearing loss afterward,” Dr. Orgel said. “We are stuck with this regimen because it works really well, but now we need to find ways to reduce the side effects.”