Ototoxicity Monitoring Navigator

Based on your answers, you reported sudden big changes in hearing (especially in one ear) and/or new neurologic warning signs such as facial weakness, trouble speaking, severe headache, vision changes, or serious difficulty walking.

These patterns may signal problems that are time-sensitive for hearing and brain health. This navigator cannot tell how serious things are, so it leans strongly toward safety.

• In many places, this combination of symptoms is treated as a medical emergency.
• If you are in the U.S. and can do so safely, consider calling emergency services (for example, 911) or going to the nearest emergency department.
• Use direct language such as: “Sudden hearing loss,” “sudden one-sided hearing loss,” or “new severe dizziness plus neurologic symptoms.”
• Tell them which treatment or medicine you’re on (for example, “I’m getting chemotherapy called cisplatin” or “I’m on strong IV antibiotics”).

After emergency issues are addressed, you can ask whether a formal hearing test and follow‑up ototoxicity monitoring are appropriate in your situation.

You haven’t started treatment yet, or you’re right at the beginning, and there hasn’t been a hearing test connected to this treatment so far.

Many programs aim for a baseline hearing test before the first dose or as close as possible to the start of chemotherapy or IV antibiotics, so that any changes later can be compared to where you started.

“Bare minimum” to ask for:

• A baseline hearing evaluation with an audiologist, ideally:
  • Before treatment begins, or
  • Within the first few days or first cycle if things are already moving quickly.
• Clarify: “If my hearing changes, who should I contact first—oncology, infectious disease, or audiology?”
• Ask whether your program typically does at least one check during treatment and one follow‑up a few months after treatment.

You’ve already had a baseline hearing test tied to this treatment. That’s a key building block of ototoxicity monitoring.

The next step is to make sure there’s a clear plan for checks during and after treatment, especially if you’re receiving medicines known to affect hearing (for example, certain “‑platin” chemotherapies or IV antibiotics ending in “‑mycin” or “‑micin”).

“Bare minimum” to ask for now:

• Confirm that your baseline will be used to watch for changes in:
  • High‑frequency hearing (often where changes show up first).
  • Speech‑range hearing that affects everyday communication.
• Ask whether your plan includes:
  • At least one check during treatment (for example, mid‑course), and
  • One follow‑up a few months after treatment ends.

You’re already in treatment that may affect hearing, and no one has checked your hearing specifically for this course yet.

Even if the ideal “before treatment” baseline didn’t happen, it can still help to: get a first hearing test now and then track changes from here.

“Bare minimum” to ask for now:

• A hearing evaluation with an audiologist as soon as reasonably possible during treatment.
• A plan for at least:
  • One check during treatment (this first test can double as baseline), and
  • One follow‑up a few months after treatment ends.
• Clear instructions on who to call if you notice new tinnitus, muffled hearing, or imbalance: oncology/ID, audiology, or primary care.

You’re in the middle of treatment, and you’ve had at least one hearing test connected to this course. That’s a solid start.

For many high‑risk treatments (such as cisplatin or certain IV antibiotics), programs aim for:

• A baseline near the start of treatment,
• At least one check during treatment (often focused on the highest frequencies first), and
• Post‑treatment follow‑up to see where things settle over time.

Questions you can bring to your team:

• “When is my next planned hearing check during treatment?”
• “If I notice new ringing, muffled hearing, or imbalance, can I be seen sooner than the routine schedule?”
• “Will we also check hearing a few months after treatment ends?”

Your treatment has ended within about the last year, and there hasn’t been a formal hearing test linked to that care.

Some people notice changes only after treatment is done. Even if you’re not sure anything has changed, it can help to get a “new baseline” now, in case things shift later.

“Bare minimum” to ask for:

• A hearing evaluation with an audiologist sometime in the first year after treatment— sooner if you’ve noticed ringing, muffled hearing, or imbalance.
• A chance to talk about:
  • Whether your past treatment carries ongoing risk to hearing.
  • How often (if at all) ongoing hearing checks are recommended for you.

You’ve already had at least one hearing test connected to your past treatment. That’s helpful for understanding where things landed.

Depending on how your hearing looks now, your care team might recommend:

• Watching and re‑checking only if new symptoms appear, or
• Periodic monitoring, especially if you had high‑risk treatment to the ears or head/neck.

Questions to bring to your next visit:

• “Does my hearing test suggest I should have regular follow‑up (for example, yearly)?”
• “If I notice new ringing, muffling, or imbalance, how quickly should I try to be seen?”
• “Are there things I can do now (like hearing protection or devices) to protect or support my hearing?”

You’re on one or more long‑term medicines, or you’re not sure whether your medicines affect hearing. Over time, medicine combinations, kidney function, and other health conditions can all influence risk.

Reasonable starting steps:

• Ask your primary care clinician or specialist for a medication review that includes hearing risk. Typical medicines people ask about include:
  • Certain water pills (loop diuretics).
  • Some IV antibiotics and chemotherapy drugs.
  • Long‑term very high‑dose aspirin or related medicines.
• If you haven’t had one, consider a baseline hearing test so you have a reference going forward.

You’re already getting periodic hearing tests. That’s an important safety net, especially if you’re on medicines with potential hearing side effects.

Questions to refine your plan:

• “Given my medicines and health conditions, how often do you recommend hearing checks?”
• “If my medicines change—for example, if we add a chemo drug or strong IV antibiotic—should my hearing monitoring change too?”
• “If I notice sudden changes between routine visits, how should I get back to you—portal message, phone call, or urgent visit?”

You’re using this navigator in a professional role. It’s designed to give patients and families language and expectations around ototoxicity monitoring, based on widely used concepts such as:

• Baseline audiometry (including extended high frequencies) before or soon after treatment starts.
• Targeted monitoring during treatment, often using high‑frequency and SRO‑based approaches.
• Post‑treatment follow‑up to characterize outcomes and support rehabilitation.

Local protocols will rightly vary by cancer center, ID service, and resources. This tool is meant to support conversations like:

• “Here’s why we’re recommending a baseline before your first cisplatin cycle.”
• “Even if we can’t see you before every dose, here’s our minimum monitoring plan.”
• “If you notice X, Y, or Z between visits, that’s a reason to let us know sooner.”

The combination of answers you chose doesn’t clearly land in one of the main paths this tool uses (before treatment, during treatment, after treatment, or long‑term medicines).

That’s okay—real life is messy, and this navigator is only a rough guide. You can:

• Revisit the earlier questions and choose the closest‑fitting options, or
• Use these core questions at your next visit:
  • “Does anything I’m taking now affect hearing or balance?”
  • “Should I have a baseline or follow‑up hearing test?”
  • “If I notice sudden changes, who do I contact first?”