Hearing after head and neck cancer treatment
Treatment for head and neck cancer may cause changes to your hearing. This can affect your ability to communicate.
Hearing can sometimes be affected after treatment for some types of head and neck cancer, such as nasopharyngeal cancer. Hearing loss may start slowly in the first 2 years after treatment.
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.
Your cancer specialist will tell you if there is a chance that treatment may affect your hearing.
Types of hearing loss
There are two main types of hearing loss:
Sensorineural hearing loss (SNHL)
SNHL is caused by damage to tiny nerve hairs in the cochlea or to the nerve in the inner ear (auditory nerve). This makes it difficult to hear soft sounds and to tell some sounds apart.
Conductive hearing loss
This 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
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 at a higher volume than usual
- needing subtitles on films or TV programmes.
Tell your GP or specialist if you have problems with your hearing. They can refer you to a hearing specialist (audiologist) or an ENT (ear, nose and throat) surgeon for further tests. This includes a hearing test (audiometry).
If you have hearing loss, you will be assessed by an ENT surgeon and audiologist. Treatment will depend on the cause of your hearing loss.
The most common treatments for hearing loss include:
- removing wax from the ear canal
- 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.
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 use the controls
- change the batteries
- use it in different situations
- clean and check the hearing aid.
You can also talk to your doctor about what may help with any hearing loss.
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. Some people find it affects their concentration or sleep. But there are ways of managing it.
Learn more about tinnitus
Wearing a hearing aid (if you have hearing loss)
Use other sounds to distract you
Learn relaxation techniques
Here are some tips for communicating if you have hearing loss:
- Tell people your hearing is not good.
- Find a well-lit place to have your conversation so that you can clearly see their face. This can help you to lip-read.
- Ask the person talking to face you and get your attention before speaking.
- 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 a conversation can be more difficult. Asking one person in the group to tell you what has been said may help.
Getting used to changes in your hearing can take time, but support is available. Hearing clinics may have information about 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 hearing loss. They can advise you on specialist equipment like smoke alarms.
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. There are also apps to help people with hearing difficulties.
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.
There are organisations that provide more information on tinnitus and hearing loss. These include:
Below is a sample of the sources used in our head and neck cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
British Association of Head and Neck Oncologists. Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines. 2016. Available from: https://www.bahno.org.uk/_userfiles/pages/files/ukheadandcancerguidelines2016.pdf (accessed September 2018).
Brockstein BE, Stenson KM, Song S. Overview of treatment for head and neck cancer. UpToDate https://www.uptodate.com/contents/overview-of-treatment-for-head-and-neck-cancer (accessed Spetember 2018).
National Institute for Health and Care Excellence (NICE). Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over. 2016. Available from: https://www.nice.org.uk/guidance/ng36 (accessed September 2018).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Chris Alcock, Consultant Clinical Oncologist.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.