Effects on hearing after treatment

Hearing may sometimes be affected after treatment for some types of head and neck cancer, such as nasopharyngeal cancer. Hearing loss may start gradually in the first two years after treatment. Your cancer specialist will have told you if your hearing could be affected.

If you have hearing loss, a surgeon and audiologist will assess you and advise on treatment.

The most common treatments for hearing loss include:

  • removing wax from the ear
  • antibiotics to treat infection
  • a small operation to insert a tiny tube (grommet) into the ear to drain fluid
  • a hearing aid to increase the volume of sound.

A small number of people may have an operation to have a device, called a cochlear implant, placed in their inner ear.

Radiotherapy or the chemotherapy drug cisplatin may cause ringing or other sounds in the ears. This is called tinnitus. It may improve gradually after treatment ends but sometimes it can be permanent.

Things that can help manage tinnitus include:

  • wearing a hearing aid (if you have hearing loss)
  • using other sounds to distract you
  • learning relaxation techniques.

Hearing changes

Hearing may sometimes be affected after treatment for some types of head and neck cancer, such as nasopharyngeal cancer. Hearing loss may sometimes come on gradually in the first two years after treatment.

Radiotherapy or the chemotherapy drug cisplatin may cause ringing in the ears. This is called tinnitus (see below). It often gets better as the ears recover from the effects of treatment. But it can sometimes be permanent. Your cancer specialist will have told you if the treatment you were given may affect your hearing.

The outer, middle and inner ear
The outer, middle and inner ear

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Hearing loss

There are two main types of hearing loss.

Sensorineural hearing loss (SNHL) is caused by damage to tiny nerve hairs in the cochlea or to the nerve in the inner ear (auditory nerve). It makes it difficult to hear soft sounds and to tell some sounds apart.

Conductive hearing loss is when sounds cannot pass from your outer ear to your inner ear. This is caused by a blockage in the ear, for example from a build-up of fluid or from earwax.

It is possible to have both these types of hearing loss. This is known as mixed hearing loss.

Signs of hearing loss can include:

  • difficulty hearing other people clearly and misunderstanding what they say
  • missing bits of conversation, especially in groups or when there is background noise
  • asking people to repeat something
  • listening to music or watching TV with the volume turned up higher than usual
  • using subtitles on films or TV programmes.

Tell your GP or specialist if you have problems with your hearing. They can refer you to an audiologist (hearing specialist) or an ear, nose and throat (ENT) surgeon for further tests, including a hearing (audiometry) test.

Treatments for hearing loss

If you have hearing loss, an ENT surgeon and audiologist will assess you. Treatment will depend on the cause of your hearing loss. The surgeon may be able to gently clear away any wax and debris in the ear canal.

Treating fluid in the ear

If you have a build-up of fluid in your ear because of infection, your doctor can prescribe antibiotics to treat it. Sometimes, doctors treat this fluid with a small tube called a grommet. The grommet lets fluid drain from the ear so that it doesn’t cause a blockage. It is put in during a small operation, usually under a local anaesthetic.

Hearing aids

Hearing aids can help with both types of hearing loss. They work by increasing the volume of sounds.

There are many different designs. The audiologist will explain which type is most suitable for you. They will also show you how to:

  • put the hearing aid in and operate the controls
  • change the batteries
  • use it in different situations
  • clean and check the hearing aid.

Cochlear implants

Some people who have hearing loss because of damage to their cochlea can be treated with a cochlear implant. This is a small hearing device fitted under the skin behind your ear. It is put in during an operation, under a general anaesthetic.

Your hearing specialist will explain the benefits and disadvantages of each treatment to you.

Living with hearing changes

Adapting to changes in hearing can take time, but support is available. Hearing clinics may have information on social services, support groups and lip-reading classes in your local area.

Your local authority will have a social services department to support people with a hearing disability. They can advise you on specialist equipment like smoke alerts. Hearing Link and Action on Hearing Loss are organisations that can also give you information about living with hearing changes.

There are phones that can make sounds louder and help you to hear callers more easily. There are also systems such as Next Generation Text (NGT), which enable people with hearing loss to communicate through text. Visit Next Generation Text Service to find out more.

There are also apps designed to help people with hearing difficulties. Visit Hearing Link for more information.

Support groups can be a good place to share experiences and find out what other people have found helpful. There may be a support group for people with hearing loss and their families in your area.

Here are some more tips for communicating:

  • Tell people your hearing is not good.
  • Find a well-lit place to have your meeting.
  • Ask the person talking to face you and get your attention before beginning to speak.
  • Ask them to speak clearly and not too fast.
  • Try to get rid of background noise, such as the TV or radio, when talking with people.

When you are in a group, following the conversation can be more difficult. Asking one person in the group to help you catch up may help.

Tinnitus

Tinnitus is a sound that you hear from inside your body, rather than from outside. It is often described as a ringing sound, but it can include other sounds such as buzzing, whistling, humming, whooshing or hissing. The sounds can be constant, or they can come and go. Tinnitus often gets better as your ears recover after treatment.

Living with tinnitus can be stressful and some people find it affects their concentration or sleep. But there are ways of managing it.

Things that can help include:

  • learning about tinnitus
  • wearing a hearing aid (if you have hearing loss)
  • using other sounds to distract you
  • learning relaxation techniques.

You may be referred to a tinnitus clinic to see an expert. They can help you to understand and manage it. Knowing more and understanding how you feel about tinnitus can help you cope. You can learn how to tune tinnitus out, so that over time it becomes less troublesome.

Tinnitus can be more noticeable if you have hearing loss. Things that improve your hearing can help, such as hearing aids. External sounds can help your brain to focus on something other than the internal sounds of tinnitus. Some people use background noises to distract them from tinnitus. This may be something simple like having an electric fan on or using sound recordings of breaking waves, bird song or white noise (a shushing sound). There are devices specially designed to produce sounds for people with tinnitus.

Tinnitus can be made worse by stress and anxiety. Learning ways to help you relax can lower your stress levels. Your clinical nurse specialist, GP or staff at the tinnitus clinic may be able to refer you for therapies that can aid relaxation.

The British Tinnitus Association (BTA), Hearing Link and Action on Hearing Loss have more information on tinnitus.

I put headphones on and was played a variety of sounds at various volumes. All I had to do was press a button when I heard something. Then it advanced to me hearing hissing noises with beeps and I had to press the button for the beeps. This got very difficult as the hissing noises were made louder.

Margaret