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Critical Review of Hearing Rehabilitation in Pediatric Oncology: Specific Considerations and Barriers
Journal article   Open access   Peer reviewed

Critical Review of Hearing Rehabilitation in Pediatric Oncology: Specific Considerations and Barriers

Guillaume Courbon, Laurie Lugnier, Johnnie K. Bass, Thomas E. Merchant, Thierry Morlet and Celine Richard
Current oncology (Toronto), v 32(9), p509
13 Sep 2025
DOI: https://doi.org/10.3390/curroncol32090509
PMID: 41002579
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.3390/curroncol32090509View
Published, Version of Record (VoR) Open

Abstract

Review
Cancer treatment in children, such as chemotherapy and radiation, can cause serious permanent hearing loss by damaging the external, middle, and/or the inner ear. Several factors influence how much the hearing is affected at the level of the inner ear, including the child’s age, the total treatment dose, genetic background, and the use of other therapies. The damage can also extend beyond the ear, affecting nearby bones and even the brain areas involved in hearing. While a new medication may help reduce some of the harmful effects of cisplatin-based chemotherapy, it is not suitable for all children, and its benefits are still limited. Some children may benefit from hearing devices such as cochlear implants or bone-anchored hearing aids. However, choosing the right time and type of rehabilitation is complex, especially since these devices can interfere with the MRI scans needed to monitor cancer. More research is needed to guide personalized decisions that balance hearing care with cancer surveillance. This review highlights the urgent need for better strategies to protect hearing during treatment, monitor changes early, and plan effective individualized hearing rehabilitation. It also emphasizes the importance of close collaboration between healthcare providers to support each child’s hearing and overall development. Childhood cancer treatments, including chemotherapy, radiation therapy, and combined modalities, pose significant risks to auditory function due to their ototoxic effects. Cisplatin, a chemotherapeutic agent commonly used in pediatric oncology, causes dose-dependent irreversible sensorineural hearing loss by damaging the inner ear structures, primarily through the generation of reactive oxygen species and the activation of apoptotic pathways. Radiation therapy exacerbates these effects, contributing to both sensorineural and conductive hearing loss via mechanisms such as vascular injury, inflammation, and fibrosis. The severity of hearing loss is influenced by the treatment timing, the cumulative dose, patient age, genetics, and concurrent therapies. The damaging effects of chemotherapy and radiation extend beyond the cochlea, involving the surrounding temporal bone as well as multiple levels of the auditory pathway. While pediatric patients may be candidates for bone-anchored hearing devices or cochlear implants, the need for serial imaging and the potential for implant-related MRI artifacts can complicate the timing of hearing rehabilitation. Moreover, the impact on the subcortical and cortical auditory structures may further influence the rehabilitation outcomes. This scoping review lays the foundation for future clinical and research efforts focused on the development of comprehensive pediatric guidelines for hearing preservation, monitoring, and rehabilitation, while also fostering multidisciplinary collaboration.

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Oncology
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