The short answer
Cisplatin can damage the inner ear, and the damage is cumulative and often permanent. Tinnitus and loss in the 4,000 to 8,000 Hz range usually come first. Reporting a change while doses remain is what keeps the decision open.
Cisplatin ototoxicity is cumulative, so the risk builds with every dose and does not reset between cycles.
The high frequencies from 4,000 to 8,000 Hz go first, which is why trouble hearing in noisy rooms often comes early.
NCI reports that 40% to 80% of adults treated with cisplatin have significant permanent hearing loss.
Report ringing, changed hearing or dizziness immediately, because your remaining doses are the decision still open.
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The full explanation.
Cisplatin is an effective chemotherapy drug for several cancers. It can also damage the inner ear. This damage is called ototoxicity. It is one of the few side effects where speaking up early matters more than describing it afterwards. Say something while you are still receiving the drug.
What cisplatin does to hearing
FDA prescribing information for cisplatin states: "Cisplatin for injection can cause ototoxicity, which is cumulative and may be severe." Cumulative means the risk builds with each dose you receive. It does not reset between cycles.
The label describes what it feels and sounds like: "Ototoxicity is manifested by tinnitus, hearing loss in the high frequency range (4,000 to 8,000 Hz) and/or decreased ability to hear normal conversational tones."
Tinnitus is listed first. Tinnitus is ringing, buzzing, or hissing that you hear without an outside sound. For many people it is the first thing they notice. It can appear while ordinary conversation still sounds normal to them.
The high frequencies go first. The label names the range 4,000 to 8,000 Hz. That is above most speech sounds. You can lose hearing in that band and still follow a conversation in a quiet room. People often notice trouble in noise first: a restaurant, a car, a room with several people talking. One-to-one conversation may seem fine. That does not mean nothing is happening.
Is it permanent?
Often, yes. MedlinePlus is the patient information service of the U.S. National Library of Medicine. It states plainly: "Hearing loss may be permanent in some cases."
The National Cancer Institute has reported the scale. Cisplatin leaves 40%–80% of adults with significant permanent hearing loss. In children, the figure is at least 50%. One researcher quoted by NCI describes it this way. Hearing loss from cisplatin "is not a static injury, it doesn't stay the same. It can progress over time."
The FDA label adds that "ototoxicity can occur during or after treatment and can be unilateral or bilateral." That means it may affect one ear or both. The label also notes that "deafness after the initial dose of cisplatin for injection has been reported."
Who is at higher risk
The FDA label names the risk factors: "Ototoxic effects can be more severe and detrimental in pediatric patients, particularly in patients less than 5 years of age. The prevalence of hearing loss in pediatric patients is estimated to be 40-60%. Additional risk factors for ototoxicity include simultaneous cranial irradiation, treatment with other ototoxic drugs and renal impairment."
MedlinePlus asks patients to tell the doctor two things. Say if you have had radiation therapy to the head. Say if you are taking aminoglycoside antibiotics.
Hearing tests during treatment
MedlinePlus states: "Your doctor will order tests to monitor your hearing before and during your treatment." The test is audiometry, and an audiologist does it. A test before your first dose gives a baseline. Later tests are compared against it. They can show a change in the high frequencies before you would notice one yourself.
The FDA label's wording is less firm. It says to "consider audiometric and vestibular function monitoring." It also says to "consider audiometric and vestibular testing in all pediatric patients receiving cisplatin." It says "consider" rather than requires. So monitoring practice varies between centers. If nobody has mentioned a hearing test, ask whether one is planned, and when.
Why reporting it during treatment matters
Tell your team as soon as you notice a change. MedlinePlus is specific about which symptoms, and how fast: "Tell your doctor immediately if you experience any of these symptoms: hearing loss, ringing in the ears, or dizziness."
The damage is cumulative and often permanent. So the decision that can still be influenced is the one about your remaining doses. Reporting a change now gives your oncologist information they can act on. Reporting it after your last cycle does not.
Be honest about the limits of the evidence here. The FDA cisplatin label does not set a specific rule for reducing, withholding, or stopping the drug because of hearing loss. What happens next is a judgment your oncologist makes. They weigh your hearing against how well the cisplatin is treating your cancer. And that judgment can only happen if they know.
If hearing loss has already happened
NCI notes that long-term survivors need ongoing monitoring of their hearing. It says clinicians should act promptly with devices that assist in hearing, such as hearing aids. Ask for a referral to an audiologist. Do not wait to see whether things settle.
Sources
- MedlinePlus (National Library of Medicine) — Cisplatin Injection: https://medlineplus.gov/druginfo/meds/a684036.html
- U.S. Food and Drug Administration — Cisplatin injection prescribing information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/018057s089lbl.pdf
- National Cancer Institute — Potential Cause of Cisplatin-Linked Hearing Loss Identified: https://www.cancer.gov/news-events/cancer-currents-blog/2018/cisplatin-hearing-loss
Words to know
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Common questions
What does cisplatin do to hearing?
FDA prescribing information says cisplatin can cause ototoxicity, which is cumulative and may be severe. The label describes it as tinnitus, hearing loss in the high frequency range of 4,000 to 8,000 Hz, and a decreased ability to hear normal conversational tones. Tinnitus is listed first, and for many people it is the first thing they notice, sometimes while ordinary conversation still sounds normal.
Why might I not notice the hearing loss at first?
The high frequencies go first, and 4,000 to 8,000 Hz is above most speech sounds. You can lose hearing in that band and still follow a conversation in a quiet room. People often notice trouble in noise first: a restaurant, a car, a room with several people talking. One-to-one conversation seeming fine does not mean nothing is happening.
Is it permanent?
Often, yes. MedlinePlus states plainly that hearing loss may be permanent in some cases. NCI has reported that cisplatin leaves 40% to 80% of adults with significant permanent hearing loss, and at least 50% of children. One researcher quoted by NCI describes it as not a static injury, because it can progress over time.
Who is at higher risk?
The FDA label says effects can be more severe in pediatric patients, particularly those under 5 years of age, with prevalence in children estimated at 40 to 60%. Additional risk factors are simultaneous cranial irradiation, treatment with other ototoxic drugs, and renal impairment. MedlinePlus asks patients to say if they have had radiation therapy to the head, and if they are taking aminoglycoside antibiotics.
Why does reporting a change during treatment matter so much?
Because the damage is cumulative and often permanent, the decision that can still be influenced is the one about your remaining doses. MedlinePlus says to tell your doctor immediately about hearing loss, ringing in the ears, or dizziness. The FDA label does not set a specific rule for reducing, withholding or stopping the drug because of hearing loss, so what happens next is your oncologist's judgment — and that judgment can only happen if they know.
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Written by: Cancer ExplainedSources last checked: 2026-07-23 what this meansLast updated: 2026-08-13Next planned review: 2027-01-28
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How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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