Cisplatin-Induced Hearing Loss: Incidence and Risk
Hearing loss occurs in 31% to 80% of patients receiving cisplatin, with the FDA reporting ototoxicity in up to 31% of adults treated with a single 50 mg/m² dose, while children experience substantially higher rates of 40-60%. 1
Incidence by Population
Adults
- 31% develop ototoxicity after a single dose of cisplatin 50 mg/m² 1
- Up to 80% of all cisplatin-treated patients develop hearing loss when considering cumulative exposure and long-term follow-up 2
- One older study in ovarian cancer patients found 22% developed hearing loss of at least 15 dB, with 13% in standard frequencies and 9% only in high frequencies 3
- Another study reported 15% developed high-frequency sensorineural hearing loss that was permanent and irreversible 4
Pediatric Patients
- 40-60% of children develop hearing loss, which is notably higher than adults 1, 5
- In one Thai cohort, 66% had hearing impairment and 48.9% had significant hearing loss (grade ≥2) at end of treatment 6
- All patients receiving cumulative doses >600 mg/m² developed significant hearing loss 6
Critical Risk Factors That Increase Incidence
The percentage varies dramatically based on:
- Cumulative dose: Higher doses substantially increase risk (Level A evidence) 7. Cumulative doses ≥400 mg/m² significantly increase risk 6
- Age: Younger patients, particularly those <5 years old, have higher rates due to ongoing auditory system development 7, 1
- Concomitant treatments: Aminoglycosides, vancomycin, or cranial radiotherapy increase risk 1
- Genetic factors: TPMT gene variants may contribute, though evidence is inconsistent 1
Key Clinical Characteristics
The hearing loss is:
- Bilateral and typically irreversible 1, 5
- High-frequency (4,000-8,000 Hz) initially, potentially progressing to conversational frequencies 1
- Progressive even after chemotherapy ends due to cochlear platinum retention lasting >18 months 2
- Can occur after the first dose or be delayed 1
Critical Surveillance Requirement
All patients receiving any dose of cisplatin require audiometric monitoring before initiation, before each subsequent dose, and for several years post-therapy 1. This is particularly crucial in children where hearing loss during critical developmental periods (birth through adolescence) can cause speech, language, and cognitive delays 7.
The wide range in reported incidence (15-80%) reflects differences in:
- Measurement timing (immediate vs. long-term follow-up)
- Frequency ranges tested (standard vs. high-frequency audiometry)
- Grading criteria used
- Cumulative dose exposure
- Patient age and comorbidities