Expert: Harriet B Jacobster, Au.D. - 9/18/2008

Question
Hello, and thank you for your help.  Last year, I was diagnosed with breast cancer.  After surgery, I was on broad spectrum antibiotics.  I got C-Diff and had a course of Flagyl.  Then I went right into adjuvant treatment--Adriamycin and Cytoxan (4X) followed by Taxol (1X).  I was on the anti-nausea meds Kytril, Emend, and Decadron for the first couple of days each round of AC chemo.  Only Decadron with the T.  My first AC treatment, I swelled up around my face/ears and neck.  Sounds were muffled.  This lasted about a day, then got better, but my left ear started to ring.  Then it resolved.  My second treatment, I swelled again, but not as badly, no muffling, but my right ear started to ring.  Then it resolved.  My third treatment, same swelling, and both ears started to ring.  I started reporting this after my second chemo and all my oncologist would say is it wasn't from the chemo.  A nurse in the infusion room attributed it to my anemia on chemo.  After I ended chemo for stomach problems, I had a bad colon infection and had to be on Cipro, which made them ring loudly again for a while.  Then a second C-dif and I was back on Flagyl.  It is almost a year now since  chemo ended and nine months since my last antibiotic.  They are still ringing, from low to mid-range.  My hematocrit is almost normal now, though my marrow is still some suppressed.  I don't know if that could enter into it.  I have talked to my PCP and she says there is nothing that can be done, as it is probably nerve damage, and should heal on its own.  It doesn't seem to be healing.  The chemo did put me into menopause, and I am now on Tamoxifen, so perhaps it’s partly a hormone issue.  I don't know for sure, but I am thinking the combination of antibiotics, chemo, and emend all damaged my auditory nerves and being thrust into menopause hasn’t let them heal.  I know I don't hear like I used to, but didn't have a baseline test before all this treatment, as no one advised me of possible hearing loss or tinnitus.  If I do go see a specialist now, are there any tests or treatments that may be able to better assess or help heal this issue?  Or am I stuck with it?  Do you think there is hope for it to heal over time?  What are your thoughts?  Thanks again.

Answer
Hi Janine,
Chemotherapy agents and many antibiotics, as well as many other drugs, are ototoxic, meaning they do damage to the inner ear. Sometimes this damage will reverse when the drugs are removed, but more often the damage is not reversible. Unfortunately, the longer the symptoms last, the less likely you will recover.  The damage caused can range from hearing loss to balance problems to tinnitus to all of these. You need to have a complete audiological evaluation, including auditory brainstem responses, to assess the extent of the damage.  Once you have the evaluation, treatment may consist of hearing aids and/or tinnitus retraining therapy.  You may refer to this site of the American Tinnitus Association for a lot more information as well as some referral sources: http://ata.org/
I wish you luck and good health.
Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology