Hearing Loss & Tinnitus From Cisplatin Chemotherapy

Cisplatin is an effective chemotherapy drug for several cancers, and it can damage the inner ear. This damage is called ototoxicity. It is one of the few side effects where speaking up early, while you are still receiving the drug, matters more than describing it afterwards.

FDA prescribing information for cisplatin states: "Cisplatin for injection can cause ototoxicity, which is cumulative and may be severe." Cumulative means the risk builds with each dose you receive rather than resetting between cycles.

The label describes what it feels and sounds like: "Ototoxicity is manifested by tinnitus, hearing loss in the high frequency range (4,000 to 8,000 Hz) and/or decreased ability to hear normal conversational tones."

Tinnitus is listed first. Tinnitus is ringing, buzzing, or hissing that you hear without an outside sound. For many people it is the first thing they notice, and it can appear while ordinary conversation still sounds normal to them.

The high frequencies go first. The range named in the label, 4,000 to 8,000 Hz, is above most speech sounds. You can lose hearing in that band and still follow a conversation in a quiet room. People often notice difficulty in noise first — a restaurant, a car, a room with several people talking — while one-to-one conversation seems fine. That does not mean nothing is happening.

Often, yes. MedlinePlus, the patient information service of the U.S. National Library of Medicine, states plainly: "Hearing loss may be permanent in some cases."

The National Cancer Institute has reported that cisplatin leaves 40%–80% of adults, and at least 50% of children, with significant permanent hearing loss. One researcher quoted by NCI describes it this way: hearing loss from cisplatin "is not a static injury, it doesn't stay the same. It can progress over time."

The FDA label adds that "ototoxicity can occur during or after treatment and can be unilateral or bilateral," meaning it may affect one ear or both, and that "deafness after the initial dose of cisplatin for injection has been reported."

The FDA label names the risk factors: "Ototoxic effects can be more severe and detrimental in pediatric patients, particularly in patients less than 5 years of age. The prevalence of hearing loss in pediatric patients is estimated to be 40-60%. Additional risk factors for ototoxicity include simultaneous cranial irradiation, treatment with other ototoxic drugs and renal impairment."

MedlinePlus asks patients to tell the doctor if they have had radiation therapy to the head or are taking aminoglycoside antibiotics.

MedlinePlus states: "Your doctor will order tests to monitor your hearing before and during your treatment." The test is audiometry, done by an audiologist. A test before your first dose gives a baseline; later tests are compared against it, and can show a change in the high frequencies before you would notice one yourself.

The FDA label's wording is less firm — it says to "consider audiometric and vestibular function monitoring," and to "consider audiometric and vestibular testing in all pediatric patients receiving cisplatin." Because it says "consider" rather than requires, monitoring practice varies between centers. If nobody has mentioned a hearing test, ask whether one is planned and when.

Tell your team as soon as you notice a change. MedlinePlus is specific about which symptoms and how fast: "Tell your doctor immediately if you experience any of these symptoms: hearing loss, ringing in the ears, or dizziness."

Because the damage is cumulative and often permanent, the decision that can still be influenced is the one about your remaining doses. Reporting a change now gives your oncologist information they can act on. Reporting it after your last cycle does not.

Be honest here about the limits of the evidence: the FDA cisplatin label does not set out a specific rule for reducing, withholding, or stopping the drug because of hearing loss. What happens next is a judgment your oncologist makes by weighing your hearing against how well the cisplatin is treating your cancer — and that judgment can only happen if they know.

NCI notes that long-term survivors need ongoing monitoring of their hearing, and that clinicians should intervene promptly with devices that assist in hearing, such as hearing aids. Ask for a referral to an audiologist rather than waiting to see whether things settle.

• MedlinePlus (National Library of Medicine) — Cisplatin Injection: https://medlineplus.gov/druginfo/meds/a684036.html
• U.S. Food and Drug Administration — Cisplatin injection prescribing information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/018057s089lbl.pdf
• National Cancer Institute — Potential Cause of Cisplatin-Linked Hearing Loss Identified: https://www.cancer.gov/news-events/cancer-currents-blog/2018/cisplatin-hearing-loss

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