Understanding Ototoxicity Monitoring: Protecting Your Hearing During Medical Treatment

Published on September 25, 2025

This article was written by Melanie Driscoll, Au.D., a HearingLoss.com^®-Certified provider at Eastpoint Audiology located at Louisville, Kentucky.

What Is Ototoxicity and Why Does It Matter?

When people think about cancer treatment or other lifesaving medications, hearing health isn’t usually the first thing that comes to mind. Yet, many commonly prescribed drugs — particularly chemotherapy agents, certain antibiotics, and diuretics — can harm the delicate structures of the inner ear. This condition, called ototoxicity, refers to drug- or chemical-induced damage to hearing and balance. The impact can range from temporary tinnitus to permanent hearing loss and balance disorders.

With ototoxicity, the stakes are high: Once hearing damage occurs, it is often irreversible. That’s why ototoxicity monitoring is so critical. By establishing a baseline hearing assessment before beginning treatment, and scheduling consistent monitoring throughout therapy, audiologists can detect early changes in hearing. This allows patients and their medical teams to make informed decisions — sometimes adjusting treatment to preserve hearing while still fighting the disease.

What Is Ototoxicity?

Ototoxicity occurs when medications or chemicals damage the cochlea (responsible for hearing), the vestibular system (responsible for balance), or both. This damage can occur suddenly or progress gradually over time.

Common ototoxicity symptoms include:

• Ringing or buzzing in the ears (tinnitus)
• Difficulty understanding speech, especially in noisy environments
• Feeling that sounds are muffled or distorted
• Dizziness, vertigo, or imbalance
• Sensitivity to certain sounds

In medical treatment settings — particularly for cancer patients — ototoxicity is a significant concern. Chemotherapy drugs like cisplatin and carboplatin are highly effective against tumors but are known to be among the most ototoxic medications. Unfortunately, they don’t just target cancer cells; they can also harm the hair cells in the inner ear.

Why Monitoring Matters

Hearing loss from ototoxicity can creep in unnoticed. Early symptoms like mild tinnitus or difficulty hearing high-pitched sounds are easy to dismiss — especially when patients are focused on battling cancer or serious infections. Without monitoring, patients may not realize their hearing is declining until the loss is significant and permanent.

That’s why ototoxicity monitoring is essential:

• Early detection: Audiologists can identify subtle hearing changes before patients notice them.
• Treatment adjustments: Oncologists may be able to modify chemotherapy doses or switch medications to reduce hearing risk.
• Improved quality of life: Protecting hearing means protecting communication, independence, and emotional well-being.

Think of it as protecting one of your most vital connections: the ability to hear and engage with the world around you.

Who Is at Risk?

Not everyone receiving medication will experience ototoxicity, but certain treatments and risk factors make it more likely. Patients should be aware if their medical care involves any of the following:

• Chemotherapy drugs: Especially platinum-based agents like cisplatin and carboplatin
• Aminoglycoside antibiotics: Such as gentamicin, tobramycin, and amikacin
• Loop diuretics: Like furosemide (Lasix) and bumetanide
• High-dose aspirin or NSAIDs: These can cause temporary hearing changes in some patients
• Other cancer-related treatments: Radiation to the head and neck area may increase ototoxic risk

Additional factors — such as age, preexisting hearing loss, kidney function, or simultaneous use of multiple ototoxic medications — can heighten vulnerability.
It’s also important to note that children and older adults face a higher risk. In children, whose auditory systems are still developing, ototoxic damage can interfere with speech and language development, potentially creating long-term educational and social challenges. In older adults, age-related hearing loss (presbycusis) can combine with drug-induced changes, accelerating communication difficulties and reducing independence.

Genetic factors can also play a role. Some people carry variations in their DNA that make them more sensitive to ototoxic drugs. For these patients, even standard doses can cause significant hearing damage. Additionally, anyone with kidney disease is more vulnerable, because many ototoxic drugs are processed by the kidneys; impaired kidney function can lead to higher drug concentrations in the body and greater risk to the inner ear.

Lifestyle and environmental factors shouldn’t be overlooked either. Patients with a history of frequent exposure to loud noise — such as musicians, factory workers, or military veterans — may already have impacted hearing systems that are more susceptible to further damage. Even cumulative everyday noise exposure, like listening to music at high volumes through earbuds, can compound the risk.

By understanding these risk factors, patients and their health care providers can prioritize hearing monitoring as an essential part of overall treatment planning.

How Ototoxicity Monitoring Works

The monitoring process is designed to detect hearing changes before they become permanent or disabling. Here’s what it typically involves:

1. Baseline assessment: Before treatment begins, patients undergo a comprehensive hearing test (baseline audiogram). This includes:
   • Standard pure-tone audiometry
   • High-frequency audiometry (detects early changes)
   • Otoacoustic emissions (measures cochlear hair cell function)
   • Speech-in-noise testing (assesses real-world hearing challenges)
2. Ongoing monitoring: Patients are scheduled for repeat tests during treatment. The frequency depends on the medication and risk level but often occurs before each chemotherapy cycle.
3. Post-treatment follow-up: After therapy ends, patients continue to receive periodic hearing checks to track any late-onset changes.

By comparing results over time, audiologists can spot small shifts that patients may not yet notice, allowing proactive intervention.

What Patients Can Do

Patients play a vital role in protecting their hearing health. If you are preparing for cancer treatment or another therapy involving ototoxic medications, here are some steps you can take:

• Ask for a baseline test: Advocate for a hearing assessment before your first treatment.
• Report symptoms immediately: Don’t ignore tinnitus, dizziness, or muffled hearing.
• Stay consistent with monitoring: Regular follow-up testing is essential, even if you feel your hearing is fine.
• Include an audiologist on your care team: They will provide guidance and support tailored to your hearing health.

Remember, the earlier changes are detected, the better your chances of protecting long-term hearing.

Treatment & Support Options

If hearing loss from ototoxicity does occur, there are effective solutions and support strategies:

• Hearing aids: Today’s devices don’t just amplify sound; they use advanced features like directional microphones, AI-driven speech clarity, and Bluetooth® streaming to help you stay connected.
• Cognitive health support: Because untreated hearing loss can strain the brain and contribute to issues like dementia, addressing it early helps keep your mind sharp.
• Auditory training tools: Programs like Lace AI Pro provide structured auditory training exercises. These help the brain adapt to hearing changes and strengthen communication skills.
• Balance therapy: Vestibular rehabilitation can help patients who experience dizziness or imbalance.
• Communication strategies: Simple techniques — like reducing background noise, facing speakers, or using captioning services — can make everyday life easier.

The goal isn’t just to preserve hearing — it’s to maintain full participation in life, relationships, and activities.

The Bigger Picture: Hearing and Brain Health

Hearing is more than just sound. It’s how our brains connect meaning to voices, music, and the world around us. When hearing declines, the brain works harder to fill in the gaps, often at the expense of memory and focus. Over time, this extra cognitive load can contribute to isolation, depression, and even dementia.

By proactively addressing ototoxicity-related hearing loss — with hearing aids, auditory training, and ongoing support — patients can protect not just their ears but also their brain health and overall quality of life.

Protecting Your Hearing Is Part of Protecting Your Health

Ototoxicity monitoring is a powerful way to ensure that lifesaving treatments don’t come at the cost of lifelong hearing problems. By starting with a baseline assessment, maintaining consistent monitoring, and embracing supportive solutions when needed, patients can safeguard both their hearing and their well-being.

If you or a loved one is preparing for cancer treatment, don’t overlook your hearing health. Schedule a professional hearing evaluation today — because every voice, every laugh, and every memory is worth preserving.

The Bluetooth^® word mark and logos are registered trademarks owned by Bluetooth SIG, Inc., and any use of such marks by the author is under license.

Resources

• Andreea Iațentiuc, Iustin Mihai Iațentiuc, Frăsinariu, O. E., Cozma, S. R., Oana Roxana Bitere-Popa, Raluca Olariu, Luminița Mihaela Rădulescu, Ioniuc, I., Cuciureanu, M., Mirabela Alecsa, Guma, C., & Miron, I. C. (2025). The Role of Genetic and Non-Genetic Factors in the Occurrence of Cisplatin-Associated Ototoxicity. International Journal of Molecular Sciences, 26(10), 4787–4787. https://doi.org/10.3390/ijms26104787
• Audiological ototoxicity monitoring guidelines: a review of current evidence and appraisal of quality using the AGREE II tool. (2024). International Journal of Audiology. https://www.tandfonline.com/doi/full/10.1080/14992027.2023.2278018
• Joo, Y., Cruickshanks, K. J., Klein, B. E. K., Klein, R., Hong, O., & Wallhagen, M. I. (2019). The Contribution of Ototoxic Medications to Hearing Loss Among Older Adults. The Journals of Gerontology Series A, 75(3), 561–566. https://doi.org/10.1093/gerona/glz166‌
• Recommendations for Age-Appropriate Testing, Timing, and Frequency of Audiologic Monitoring During Childhood Cancer Treatment: An International Society of Paediatric Oncology Supportive Care Consensus Report. (2021). Asha.org. https://apps.asha.org/EvidenceMaps/Articles/ArticleSummary/1d08fd2d-a3ac-ed11-8143-005056834e2b
• VA.gov | Veterans Affairs. (2025). Va.gov. https://www.ncrar.research.va.gov/OM/OMGuidelines.asp

---

At Eastpoint Audiology – Louisville, we specialize in finding the perfect hearing solutions for everyone. Our tailored approach combines best practices, advanced hearing testing, sophisticated technology, and caring and experienced local audiologists and hearing care professionals dedicated to helping you get back what you have lost. Forget everything you think you know about hearing loss, hearing aids, and other forms of hearing technology. Thanks to the incredible advances in recent years, hearing aids and assistive devices are less noticeable – and more powerful – than ever before.