Chemotherapy and Hearing Loss: Which Cancer Drugs Affect Your Ears and How to Protect Them

Some cancer drugs can permanently damage hearing. The main culprits are the platinum-based chemotherapy agents — cisplatin and, to a lesser degree, carboplatin — which are toxic to the inner ear (cochlea). They can cause permanent, high-frequency-first sensorineural hearing loss and tinnitus. The most reliable protection is a baseline hearing test before treatment, regular monitoring during it, and early action if your hearing changes. Never stop or delay cancer treatment because of hearing worries — speak to your oncology team.

Which chemotherapy drugs cause hearing loss?

The chemotherapy drugs most strongly linked to hearing loss are the platinum agents: cisplatin (highest risk) and carboplatin (generally lower risk, but significant at high or myeloablative doses). These are described as ototoxic — capable of harming the inner ear — by the American Speech-Language-Hearing Association and in Harvard Health's ototoxic-drug overview. Not every chemotherapy regimen carries this risk. If your treatment plan includes a platinum drug, ask your oncologist whether hearing monitoring is part of your care.

In our clinics we often meet patients and parents who were never told that a "life-saving" drug could also affect hearing. Knowing the risk in advance does not change the treatment decision — the cancer is treated first — but it lets you set up a baseline test and catch any change early.

How does cisplatin cause hearing loss?

Cisplatin damages the delicate hair cells of the cochlea, the sensory cells that convert sound into nerve signals. Because these cells do not regenerate, the resulting sensorineural hearing loss is usually permanent. NIH researchers have shown that cisplatin builds up in the inner ear and stays there far longer than in most other tissues, which helps explain why the loss is often lasting and can worsen over time. The damage typically affects high frequencies first, so early on you may still hear speech clearly while struggling with high-pitched sounds.

Does cisplatin cause hearing loss in children?

Yes, and children are more vulnerable than adults. Cisplatin-related permanent sensorineural hearing loss is reported in a large share of treated children — in up to 75% of children, according to the NCI/FDA discussion of paediatric otoprotection. This matters most during the years a child is learning to speak, because untreated hearing loss can hold back speech, language and classroom learning. For children on platinum chemotherapy, paediatric audiology monitoring is important, and families should ask the oncology team about otoprotection such as sodium thiosulfate where appropriate.

What is sodium thiosulfate (Pedmark) and does it protect hearing?

Sodium thiosulfate is a medicine that helps shield cochlear hair cells from cisplatin's toxic effects. In 2022 the US FDA approved it (brand name Pedmark) to reduce the risk of cisplatin-associated hearing loss in children aged one month and older with localised, non-metastatic solid tumours, as reported by the National Cancer Institute. The approval was supported by randomised trials, including SIOPEL-6 and the Children's Oncology Group ACCL0431 study. Important points to understand:

• It is given by the oncology team as part of treatment — it is not something you can buy or take on your own.
• It is approved for specific paediatric situations; suitability depends on the tumour type and treatment plan.
• Even with otoprotection, audiology monitoring is still needed to confirm hearing is being preserved.

Ask your oncologist whether it applies to your or your child's case.

Does carboplatin cause tinnitus and hearing loss?

Carboplatin is also platinum-based and can be ototoxic, though the risk is generally lower than with cisplatin. That risk rises at high or myeloablative doses, such as those used before stem-cell transplant, as noted in the Merck Manuals professional reference on drug-induced ototoxicity. Tinnitus — ringing, buzzing or hissing in the ears — often appears before a measurable drop shows on a hearing test, which is why any new ringing during treatment is worth reporting. Baseline and follow-up audiograms let your team track subtle changes and coordinate care with oncology.

Chemotherapy drugs and hearing risk: a quick comparison

• Cisplatin — Type: Platinum; Hearing-loss risk: Highest of the platinum agents; Reversible?: Usually permanent; Common early sign: High-pitch loss, tinnitus
• Carboplatin — Type: Platinum; Hearing-loss risk: Lower; higher at high/transplant doses; Reversible?: Usually permanent; Common early sign: Tinnitus, high-pitch loss
• Aspirin / NSAIDs (supportive meds) — Type: Salicylate/NSAID; Hearing-loss risk: Dose-dependent; Reversible?: Usually reversible; Common early sign: Tinnitus
• Loop diuretics (supportive meds) — Type: Diuretic; Hearing-loss risk: Higher when combined with platinum drugs; Reversible?: Often reversible; Common early sign: Muffled hearing, tinnitus

Sources: ASHA, Merck Manuals, MedlinePlus. This table is general information; your actual risk depends on your dose, other medicines and overall health.

How to protect your hearing during chemotherapy

You cannot always prevent chemotherapy-related hearing loss, but you can catch it early and manage it well:

1. Get a baseline hearing test before treatment starts. This gives your team a reference point to compare against. Book a free hearing test if one is not already arranged. 2. Attend monitoring audiograms during and after treatment. Ototoxicity monitoring is designed to spot high-frequency changes before they affect everyday speech. 3. Report new tinnitus, muffled hearing or dizziness promptly. These can be early signs. 4. Ask your oncologist about otoprotection such as sodium thiosulfate if a child is on cisplatin. 5. Tell your team about all other medicines, since some supportive drugs (like loop diuretics) can add to the risk. 6. Plan for support if hearing changes — modern hearing aids and tinnitus help can make a real difference to quality of life during and after treatment.

For patients who are unwell or immunosuppressed during treatment, we also offer a home-visit hearing test so monitoring does not mean an extra trip to the clinic.

When is a hearing change an emergency?

Gradual high-frequency loss detected on monitoring is expected and is not an emergency — it is exactly what testing is meant to find. But sudden or rapidly worsening hearing loss, especially in one ear, along with new severe dizziness or a sudden loud ringing, should be treated urgently. Contact your audiology and oncology team the same day. Sudden sensorineural hearing loss in general is a recognised medical emergency, and prompt assessment gives the best chance of a good outcome.

Talk to us about hearing monitoring

If you or a family member is starting platinum-based chemotherapy, a baseline hearing test and a simple monitoring plan can protect what matters. Our RCI-registered audiologists (MASLP/BASLP) work alongside your oncology team across Pune, Delhi and Bengaluru. Book a free hearing test, ask about home visits during treatment, or contact us or call +91 9429690093 to set up ototoxicity monitoring. No pressure — just clear, careful support.

Internal-link ideas:

• Free hearing test — baseline and monitoring audiometry for chemotherapy patients
• Hearing aids — support if treatment causes permanent loss
• Tinnitus help — for chemo-related ringing in the ears
• Home-visit hearing test — monitoring at home for patients in treatment
• Contact / book an appointment — set up ototoxicity monitoring
• Future: a dedicated "Ototoxicity monitoring / diagnostic audiometry" service page to link from "monitoring audiograms" mentions