Effects on hearing after head and neck cancer treatment

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 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 suggest 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

Treatment for some types of head and neck cancer, such as nasopharyngeal cancer, can sometimes affect your hearing. 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. It often gets better as your ears recover from the effects of treatment. But it can sometimes be permanent. If there is a chance that treatment may affect your hearing, your cancer specialist will explain this beforehand.

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). This 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 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 (audiometry) test.

Treatments for hearing loss

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 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 an infection, your doctor can prescribe antibiotics to treat it.

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 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.

Living with hearing changes

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 alerts. Hearing Link and Action on Hearing Loss 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.

There are also apps to help people with hearing difficulties. Hearing Link have more information about apps.

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. Find out more.

Here are some more tips for communicating if you have hearing loss:

  • Tell people your hearing is not good.
  • Find a well-lit place to have your conversation.
  • 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.

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. Some people find it affects their concentration or sleep. But there are ways of managing it.

Things that can help include the following:

  • Learning about tinnitus. You may be referred to a tinnitus clinic to see an expert. They can help you to understand and manage it. Knowing about tinnitus can help you cope. You can learn how to make the tinnitus less noticeable.
  • Wearing a hearing aid (if you have hearing loss). Tinnitus can be more noticeable if you have hearing loss. This means things that improve your hearing might help, such as hearing aids. External sounds can help your brain to focus on something else.
  • Using other sounds to distract you. Some people use background noises to distract them. This may be something simple like playing the radio or having an electric fan on. Or it could include using sound recordings of breaking waves, birdsong or white noise (a shushing sound). There are devices specially designed to produce sounds for people with tinnitus.
  • Learning relaxation techniques. Tinnitus can be made worse by stress and anxiety. Learning ways to help you relax can lower your stress levels. Your specialist nurse, 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.