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Late Effects of the Special Senses

Hearing

Children treated for malignancies may be at risk for early- or delayed-onset hearing loss that can affect learning, communication, school performance, social interaction, and overall quality of life. Hearing loss as a late effect of therapy can occur after exposure to platinum compounds (cisplatin and carboplatin) and cranial irradiation. Children are more susceptible to ototoxicity from platinum agents than adults.[1,2] Risk factors associated with hearing loss with platinum agents include the following:

Younger age.
Higher cumulative dose of chemotherapy.
Central nervous system (CNS) tumors.
Concomitant CNS radiation.

For cisplatin, the risk of significant hearing loss involving the speech frequencies (500-2000 Hz) usually occurs with cumulative doses that exceed 400 mg/m² in pediatric patients.[1,3] Ototoxicity after platinum chemotherapy can present or worsen years after completion of therapy. In 59 patients who had received cisplatin, 51% of them developed late-onset hearing loss (occurring at least 6 months after the last dose of cisplatin). Radiation to the posterior fossa and the use of hearing aids were associated with late-onset hearing loss.[4,5] Carboplatin used in conventional (nonmyeloablative) dosing is typically not ototoxic.[6] A single study observed ototoxicity after the use of non-stem cell transplant dosing of carboplatin for retinoblastoma, in that 8 children out of 175 developed hearing loss. For seven of the eight children, the onset of the ototoxicity was delayed a median of 3.7 years.[7] With myeloablative dosing, carboplatin may cause significant ototoxicity. For carboplatin, ototoxicity has been reported to occur at cumulative doses exceeding 400 mg/m².[8]

Cranial radiation therapy, when used as a single modality, results in ototoxicity when cochlear dosage exceeds 32 Gy. Young patient age and presence of a brain tumor and/or hydrocephalus can increase susceptibility to hearing loss. The onset of radiation-associated hearing loss may be gradual, manifesting months to years after exposure. When used concomitantly with cisplatin, radiation therapy can substantially exacerbate the hearing loss associated with platinum chemotherapy.[9,10,11]

Table 13. Auditory Late Effects

Predisposing Therapy	Potential Auditory Effects	Health Screening/Interventions
Platinum agents (cisplatin, carboplatin); radiation impacting the ear	Ototoxicity; sensorineural hearing loss; tinnitus; vertigo	History: hearing difficulties, tinnitus, vertigo
Otoscopic exam
Audiology evaluation
Amplification in patients with progressive hearing loss
Speech and language therapy for children with hearing loss
Otolaryngology consultation in patients with chronic infection, cerumen impaction, or other anatomical problems exacerbating or contributing to hearing loss
Educational accommodations (e.g., preferential classroom seating, FM amplification system, etc.)

Orbital and Optic

Orbital complications are common following radiation therapy for retinoblastoma, childhood head and neck sarcomas, and CNS tumors, and as part of total-body irradiation (TBI).

For survivors of retinoblastoma, a small orbital volume may result from either enucleation or radiation therapy. Age younger than 1 year may increase risk, but this is not consistent across studies.[12,13] Progress has been made in the management of retinoblastoma with better enucleation implants, intravenous chemoreduction, and intra-arterial chemotherapy in addition to thermotherapy, cryotherapy, and plaque radiation. Longer follow-up is needed to assess the impact on vision in patients undergoing these treatment modalities.[12,14,15,16] Previously, tumors located near the macula and fovea were associated with an increased risk of complications leading to visual loss, although treatment of these tumors with foveal laser ablation has shown promise in preserving vision.[16,17,18,19,20,21,22] (Refer to the PDQ summary on Retinoblastoma Treatment for more information on the treatment of retinoblastoma.)

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WebMD Public Information from the National Cancer Institute

Last Updated: October 07, 2011

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