What specific questions should I ask a female patient experiencing increased auditory perception and aural fullness while receiving oxaliplatin, cetuximab, and 5‑fluorouracil chemotherapy?

Telephone Assessment Questions for Auditory Symptoms During Oxaliplatin-Based Chemotherapy

When assessing this patient's auditory symptoms by phone, focus your questions on distinguishing between ototoxicity, Eustachian tube dysfunction, and acute neurologic complications, as oxaliplatin can cause rare but documented hearing loss despite being considered less ototoxic than other platinum agents 1, 2.

Critical Initial Questions

Symptom Characterization

• Onset and timing: When did these symptoms start relative to your last chemotherapy infusion? Did they begin suddenly or gradually?
• Laterality: Is this affecting one ear or both ears? If one side, which ear?
• Severity progression: Are the symptoms getting worse, staying the same, or improving since you first noticed them?

Specific Auditory Features

• Hearing changes:
  • Can you hear sounds that were previously normal, or is everything muffled?
  • Are high-pitched sounds (like children's voices, birds chirping) harder to hear than low-pitched sounds?
  • Do voices sound distorted or robotic, or just quieter?
• Aural fullness: Does your ear feel plugged like you're on an airplane, or is it different?
• Tinnitus: Do you hear ringing, buzzing, or other noises in your ears?
• Autophony: Can you hear your own voice unusually loudly inside your head?

Red Flag Screening

Neurologic Emergency Exclusion

Ask specifically about symptoms that would indicate posterior reversible encephalopathy syndrome (PRES) or other acute complications 1:

• Vision changes: Any blurry vision, double vision, or vision loss?
• Headache: New or severe headache?
• Confusion or altered mental status: Any difficulty thinking clearly or confusion?
• Seizures: Any shaking episodes or loss of consciousness?
• Balance problems: Dizziness, vertigo, or difficulty walking?

Vestibular Assessment

• Vertigo: Do you feel like the room is spinning, or just lightheaded?
• Balance: Can you walk normally, or do you feel unsteady?
• Nausea/vomiting: Associated with the hearing symptoms?

Contextual Risk Factors

Treatment History

• Cumulative dose: How many cycles of oxaliplatin have you received? (Document total exposure)
• Recent infusion: When was your most recent chemotherapy? (Ototoxicity can occur suddenly even after multiple cycles 3, 4, 5)
• Other ototoxic exposures: Are you taking any other medications like aminoglycosides, loop diuretics, or aspirin?

Pre-existing Conditions

• Baseline hearing: Did you have any hearing problems before starting chemotherapy?
• Noise exposure: Recent loud noise exposure?
• Upper respiratory symptoms: Any cold, sinus congestion, or allergies?
• Ear trauma or infection: Recent ear pain, drainage, or injury?

Physical Limitations Assessment

• Eustachian tube function:
  • Can you pop your ears by swallowing or yawning?
  • Does the fullness change when you pinch your nose and gently blow?
  • Any recent airplane travel or altitude changes?

Functional Impact

• Communication difficulty: Can you understand conversation on the phone right now, or is it difficult?
• Safety concerns: Can you hear alarms, doorbells, or traffic?
• Work/daily activities: Is this interfering with your ability to function safely?

Clinical Reasoning

The FDA label acknowledges that oxaliplatin can cause various neurologic toxicities but does not specifically list ototoxicity as a common adverse effect 1. However, emerging research demonstrates that oxaliplatin induces cochlear synaptopathy—a form of "hidden hearing loss" where thresholds remain normal but suprathreshold neural function is impaired 2. Case reports document sudden, often irreversible hearing loss with oxaliplatin 3, 4, 5, though one small study found no ototoxicity 6.

The combination of increased volume perception, aural fullness, and autophony (hearing own breathing) suggests either Eustachian tube dysfunction or early cochlear involvement. Given the patient is on oxaliplatin, you must rule out true ototoxicity, which requires urgent audiological evaluation if confirmed 7.

Immediate Next Steps Based on Responses

• If sudden unilateral hearing loss with no Eustachian tube symptoms: Treat as potential sudden sensorineural hearing loss—urgent ENT referral within 24-48 hours
• If bilateral symptoms with autophony and fullness that improves with Valsalva: Likely Eustachian tube dysfunction—trial of decongestants and close follow-up
• If any PRES symptoms (vision changes, headache, confusion): Emergency department evaluation immediately 1
• If progressive bilateral high-frequency hearing loss: Formal audiometry before next chemotherapy cycle; consider oncology consultation regarding treatment modification 7

Document all responses carefully, as baseline audiometric testing should have been performed before platinum therapy but often is not 8, 9. Any confirmed hearing changes require audiological referral and oncology notification to weigh risks versus benefits of continuing oxaliplatin 7.