Ototoxicity (Ear Poisoning) in Children

Ototoxicity (Ear Poisoning) in Children

Often, kids who take high doses of medicines for cancer, infections, or other health problems develop hearing or balance issues (or both) as a result of taking the drugs. This is called ototoxicity or “ear poisoning.”

Ototoxicity harms the inner ear– the part of the ear accountable for receiving/sending sounds and managing balance. The degree of damage depends upon what type of drug a child is taking, how much, and for the length of time. Some kids may have no problems or extremely minimal hearing loss and “calling in the ears” (ringing in the ears). However other kids may have major issues with balance and/or extensive hearing loss (deafness).

When ototoxicity is caught early, physicians can work to prevent problems from becoming worse and get kids the rehab they need to deal with any damage that’s been done.

Ototoxicity of a compound indicates that the compound is hazardous or dangerous to the ear. The toxic impacts take place in specific parts of the inner ear like the cochlea which is involved in hearing, the vestibular system which is responsible for balance, and/ or the vestibulo-cochlear nerve which carries signals from the ear to the brain.

Ototoxicity (Ear Poisoning) in Children

Symptoms and signs

The symptoms of ototoxicity can come on suddenly after a course of medicine or show up gradually with time.

Some kids might discover obvious hearing problems, generally in both ears (called bilateral hearing loss). They may have problem hearing particular things, from high-pitched noises to talking if there’s background sound. Or they might have ringing in the ears, which can cause annoying ringing in the ears along with other unusual seem like hissing, buzzing, humming, and roaring.

Often, though, there’s just limited damage, and kids may not even see a problem. Or they may simply have a difficult time hearing high-frequency sounds while everything else sounds completely clear.

Signs of hearing issues in kids include:

  • restricted, poor, or no speech
  • being often neglectful
  • having problems in school or trouble discovering
  • continuously turning up the volume on the TV or stereo
  • not reacting to conversation-level speech or noises as expected (in babies and pre-verbal children, this would imply not surprising or turning their heads when they hear a loud sound)
  • ending up being tired more quickly or more frequently after hours of cautious listening (such as after school)

When balance is affected, kids may fall a lot and have symptoms of disequilibrium– an unsteady “woozy” sensation that makes it hard to stand up, walk, or climb the stairs without falling. They may walk with their legs too far apart or be unable to walk without staggering. And walking in the dark can also be difficult.

In the most severe cases, vision can be affected. Kids might see images that bounce, leap around, or look blurry whenever they move their heads (this is called oscillopsia).

These balance and vision issues may cause frequent headaches, and kids likewise might feel lightheaded, lightheaded, or disoriented. They may have reading difficulties, such as needing more time to adapt their vision when switching from reading a book to reading something at a range. Queasiness, vomiting, diarrhea, and modifications in heart rate and blood pressure also can occur.

Ototoxicity (Ear Poisoning) in Children


There’s no chance to test if a drug has actually triggered ototoxicity, however medical professionals have a respectable concept of which medications can increase a child’s risk. Before your child takes any new medicine, ask your doctor about any potential side effects so that you understand what to expect and look for.

If the doctor informs you that a drug has a significant ototoxicity risk, he or she might suggest that your child frequently see an audiologist (hearing specialist) or vestibular therapist (somebody trained in dealing with balance issues), who can look for potential problems. Be sure to follow the testing schedule the doctor provides you, even if you don’t see any modification in hearing or balance. Regular, repetitive testing is the best way to catch an ototoxic impact early.

If your child may be affected, the doctor might inspect hearing or balance abilities, or refer you to an audiologist or otolaryngologist (ear, nose, and throat professional) for tests. These can consist of:

  • Behavioral hearing tests. These involve careful observation of a child’s action to seem like adjusted speech and pure tones. Pure tones are the unique pitches (frequencies) of sounds. The tests are used to keep an eye on the limits of hearing for various noises.
  • Auditory brainstem action (ABR) test. Tiny earphones are put in the ear canals and electrodes (small stickers) are placed on the scalp and behind the ears. The electrodes measure the actions from the auditory (hearing) nerve and from other essential auditory centers in the brain stem.
  • Otoacoustic emissions (OAE) test. A small probe is placed in the ear canal, then lots of pulse-type sounds are presented and an “echo” reaction from cells in the inner ear is recorded. A normal recording shows that noises are magnified generally by the inner ear. This test, in addition to the ABR, is commonly used on babies, babies, and kids.
  • Electronystagmogram (ENG). To assess balance, a computer keeps an eye on uncontrolled eye motions (called nystagmus) while a child is asked to focus on a visual target, or while hot or cold water is injected into the ear canal. The head might likewise be moved into different positions while physicians observe eye movements.
  • Posturography. This test determines a child’s capability to balance while basing on a stable or unstable platform.
  • Balance questionnaires. A child who is old enough to describe a medical problem may be inquired about the level of lightheadedness experienced throughout the day while doing various activities.

While these tests can identify hearing or balance issues, the majority of problems from ototoxicity usually go unnoticed. That’s since kids might have really minimal hearing loss with symptoms that do not appear worth informing parents or medical professionals about. Some might not discover anything.

And balance problems can be even harder to spot, since kids have a much harder time than grownups acknowledging and describing balance problems.


Research continues methods to avoid or reverse ototoxicity, but so far there’s no sure way to reverse it.

The good news, however, is that the ear may just require time to recover. And some kids might have no additional hearing or balance issues if they can stop taking the medication that’s causing their symptoms.

Also, physicians might alter the dose or the medication. However, that’s not constantly a choice– certain drugs are essential to eliminating particular infections or diseases. When changing to a different drug or lowering the dose isn’t possible, kids may benefit from auditory or listening therapy and speech (lip) reading.

Kids with severe damage to the inner ear also might require an amplification device, hearing aid, or cochlear implant:

  • An amplification device called an FM system can help reduce background noise. FM systems, sometimes called “auditory trainers,” might be offered in the classroom to enhance hearing in group or noisy environments and also can be fitted for individual or home use. Other assistive listening or notifying devices might assist older kids.
  • Hearing aids come in various forms that fit inside or behind the ear and make sounds louder. They are adjusted by an audiologist so that the noise being available in is enhanced enough to permit the person to hear it plainly.
  • In some cases, the hearing loss is so severe that the most effective listening devices cannot magnify the noise enough. In those cases, a cochlear implant may be advised.
  • Cochlear implants are surgically implanted devices that bypass the harmed inner ear and send out signals directly to the auditory nerve. A little microphone behind the ear picks up acoustic waves and sends them to a receiver that has been positioned under the scalp. This receiver then transfers impulses straight to the acoustic nerve. These signals are viewed as sound and allow the individual to hear.

Kids who have balance problems will go through balance therapy (also called vestibular rehab) with a physical or vestibular therapist. This might include training exercises that help enhance balance skills and coordination. Exercises may involve flexing down, standing or walking with eyes open and then with eyes closed, or having a therapist reposition the child’s head at various angles to move fluid or debris from particular parts of the ear.

Early Detection Is Secret

The earlier a child is diagnosed with ototoxicity, the faster treatment can begin.

In the really young, it’s especially important to catch it early. That’s due to the fact that babies and toddlers have to be able to hear voices and conversations plainly in order to fully develop their speech and language abilities. For older kids, hearing issues can impact how they interact socially and communicate with others and how they do in school. And balance problems can have a huge effect on kids of any age, especially given that it can put them at risk for harmful falls.

If your child is having hearing and/or balance problems and is taking high dosages of medicines, speak with your doctor. Make certain to mention all your child’s symptoms, whether they seem associated or not. For instance, you might not think things like trouble walking or taking note in school might have anything to do with the ears, but they might.

If you’re worried about any medication your child is taking, always call your doctor– never change the dose or stop providing your child a medicine without speaking with your doctor first.

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