Home > Disclaimer > Late Effects


Late Effects



Radiation Therapy (RT) Toxicity


Children who have primary tumors of the head and neck area or brain frequently need radiation therapy (RT) as part of their curative therapy.

RT given to the external, internal and middle ear can cause damage to these structures1

Side effects can occur both during treatment (early) and months to years following therapy (late)3


Early Effects:

  • Desquamation of the columnar epithelium lining the ears and covering the ossicles
  • Edema of the mucosa within the ear3
  • Otitis media: inflammation and fluid accumulation in middle ear


Late Effects:

Hearing loss secondary to RT is usually permanent and can be sensorineural or conductive depending on the structures affect by the RT3

External Ear:

  • Altered production of cerumen along with epithelial desquamation leading to plugging of the ear canals which persists after the completion of therapy3
  • Direct effects of RT on cartilaginous structures may lead to stenosis or necrosis of the ear canal and chronic RT induced otitis and hearing loss3 
  • Chrondronecrosis can also occur in the cartilage of the external ear3

Middle Ear:

  • Scarring and damage to ossicles as a result of RT

Inner Ear:

  • Cranial RT when used alone typically results in ototoxicity only when cochlear dosage exceeds 30 Gy4
  • Sensorineural hearing loss can occur as a result of the radiation affecting the connection between the auditory cortex and cochlea3


RT induced hearing loss usually occurs many years after treatment if it is the only modality given as treatment3

Combination RT and chemotherapy can result in hearing loss within the first few years after therapy3




Key Factors

Contributory Factors

Radiation Therapy (RT) Risk Factors

Dose of 30 Gy or more4


RT given concurrently or sequentially with other ototoxic drugs:


  • cisplatin
  • myeloablative doses of carboplatin
  • aminoglycosides4

Younger age at treatment4


Higher radiation dose4


Chronic otitis or cerumen impaction before treatment4


CNS tumor4


CSF shunting4



Back to top