Key Points for This Section
- Hearing problems are a late effect that is more likely to occur after treatment for certain childhood cancers.
- Radiation to the brain and certain chemotherapy drugs increase the risk of hearing loss.
- Hearing loss is the most common sign of hearing late effects.
- Certain tests and procedures are used to detect (find) and diagnose health problems in the ear and hearing problems.
- Eye and vision problems are a late effect that is more likely to occur after treatment for certain childhood cancers.
- Radiation to the brain or head increases the risk of eye problems or vision loss.
- Late effects that affect the eye may cause certain health problems.
- Possible signs and symptoms of eye and vision late effects include changes in vision and dry eyes.
- Certain tests and procedures are used to detect (find) and diagnose health problems in the eye and vision problems.
The risk of hearing loss may be increased in childhood cancer survivors after treatment with either of the following:
- Certain chemotherapy drugs, such as cisplatin or high-dose carboplatin.
- Radiation therapy to the brain.
Risk may also be increased in childhood cancer survivors who were young at the time of treatment (the younger the child, the greater the risk) or received radiation therapy to the brain and chemotherapy at the same time.
- Hearing loss.
- Ringing in the ears.
- Feeling dizzy.
- Too much hardened wax in the ear.
Hearing loss may occur slowly over time or may occur several months or years after treatment ends. Talk to your child's doctor if your child has any of these problems.
These and other tests and procedures may be used to detect or diagnose hearing late effects:
- Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Otoscopic exam: An exam of the ear. An otoscope is used to look at the ear canal and the eardrum to check for signs of infection or hearing loss. Sometimes the otoscope has a plastic bulb that is squeezed to release a small puff air into the ear canal. In a healthy ear, the eardrum will move. If there is fluid behind the eardrum, it will not move.
- Hearing test: A hearing test can be done in different ways depending on the child's age. The test is done to check if the child can hear soft and loud sounds and low- and high-pitched sounds. Each ear is checked separately. The child may also be asked if he or she can hear the high-pitched hum of a tuning fork when it is placed behind the ear or on the forehead.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of hearing late effects. If tests are needed, find out how often they should be done.
Treatment for these and other childhood cancers may cause eye and vision late effects:
- Retinoblastoma, rhabdomyosarcoma, and other tumors of the eye.
- Brain tumors.
- Head and neck cancers.
- Cancers treated with total-body irradiation (TBI) before a stem cell transplant.
The risk of eye problems or vision loss may be increased in childhood cancer survivors after treatment with any of the following:
- Radiation therapy to the brain, eye, or eye socket.
- Surgery to remove the eye.
- Total-body irradiation (TBI) as part of a stem cell transplant.
- Certain chemotherapy drugs, such as busulfan.
- Stem cell transplant and a history of chronic graft-versus-host disease.
Eye late effects include the following:
- Having a small eye socket that affects the shape of the child’s face as it grows.
- Loss of vision.
- Vision problems, such as cataracts or glaucoma.
- Not being able to make tears.
- Damage to the optic nerve and retina.
- Eyelid tumors.
These and other signs and symptoms may be caused by eye and vision late effects or by other conditions:
- Changes in vision, such as:
- Not being able to see objects that are close.
- Not being able to see objects that are far away.
- Double vision.
- Cloudy or blurred vision.
- Colors seem faded.
- Seeing a glare or halo around lights at night.
- Dry eyes that may feel like they are itchy, burning, or swollen, or like there is something in the eye.
- Eye pain.
- Eye redness.
- Having a growth on the eyelid.
Talk to your child's doctor if your child has any of these problems.
These and other tests and procedures may be used to detect or diagnose eye and vision late effects:
- Eye exam with dilated pupil : An exam of the eye in which the pupil is dilated (widened) with medicated eye drops to allow the doctor to look through the lens and pupil to the retina. The inside of the eye, including the retina and the optic nerve, is checked using an instrument that makes a narrow beam of light. This is sometimes called a slit-lamp exam. The doctor may take pictures over time to keep track of changes in the size of the tumor and how fast it is growing.
- Indirect ophthalmoscopy : An exam of the inside of the back of the eye using a small magnifying lens and a light.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of eye and vision late effects. If tests are needed, find out how often they should be done.