Few members of the pharmacology and biotechnology communities would deny that hearing is
generally important. However, when considering the necessity for ototoxicity screening and
prevention, many drug developers and regulatory experts assume that only severe
consequences of ototoxicity (profound hearing loss and deafness) are worthy of preventative
efforts in children. It is often concluded that if a drug causes mild to moderate hearing loss, this
is a small and acceptable price to pay for the drug’s therapeutic benefits. In reality, though,
there is significant evidence in pediatric hearing literature that even mild or delayed hearing
impairment leads to high costs for children in terms of overall health, psychological well-being,
and social integration (Bass et al., 2016).
One area in which children with mild or moderate hearing loss suffer is education (Bass et al.,
2016; Hornsby et al., 2017). A large, education-based study showed that children with minimal
hearing loss (approximately 5% of 1,200 students surveyed) exhibited significantly lower test
scores on comprehensive basic skills tests in third grade, and 37% of surveyed students with
minimal hearing loss had failed at least one grade (Bess et al., 1998). In another study of older
children who survived cancer treatment but experienced ototoxic hearing loss, the risk of
learning difficulty in reading, math, and general studies was at least twice as high as normal
hearing cancer survivors (Gurney et al., 2007).
Mild to moderate hearing loss can also lead to increased fatigue and stress for students. In a
study of 60 students with mild or moderate hearing loss (mean pure tone average threshold of
36 dB), self-reported classroom fatigue was significantly higher compared to normal hearing
students (Hornsby et al., 2017). This was presumably due to the increased attention and
concentration needed for listening in the classroom. Increased classroom fatigue is also related
higher levels of stress experienced by students with hearing loss, again likely due to the higher
demands on students to listen during school (Bess et al., 2016).
Given the educational consequences of mild to moderate hearing loss caused by ototoxicity,
federal and state governments may be motivated to promote regulations that limit harm to the
ears. Under the Individuals with Disabilities Education Act, funding for assistive hearing devices
in classrooms and audiological services is required, and Individualized Educational Programs
must be developed for hearing-impaired students who qualify for special education services
(Bass et al., 2016). Thus, in addition to protecting the public from ototoxic drugs, governments
could reduce education costs, even for students with mild or moderate acquired hearing loss,
by requiring better preventative measures against ototoxicity.
Outside of the classroom, children with mild or moderate hearing loss suffer from a variety of
psychosocial problems. Such children display lower observed and self-reported quality of life
scores (Gurney et al., 2007), and significantly greater dysfunction than children with normal
hearing in terms of behavior, energy, stress, social support, and self-esteem (Bess et al., 1998).
Hearing impairment clearly puts children with mild or moderate hearing loss at a disadvantage
in terms of educational performance and psychosocial well-being. Even as adults the
consequences can be significant. Children with hearing loss are up to 39% less likely to attend
college, are twice as likely to experience work stress, and have lower labor participation rates
than normal hearing individuals (Roland et al., 2016). This broad range of consequences
suggests that ototoxicity need not result in deafness to deserve our attention. Instead, it would
be logical for the pharmaceutical industry and regulatory bodies to focus on improved
screening and prevention of ototoxicity to help all potential sufferers.
Bass, J.K., Knight, K.R., Yock, Y.I., Chang, K.W., Cipkala, D., & Grewal, S.S. (2016). Evaluation and management of hearing loss in survivors of childhood and adolescent cancers: a report from
the Children’s Oncology Group. Pediatr Blood Cancer 63(7), 1152-1162.
Bess, F.H., Dodd-Murphy, J., & Parker, R.A. (1998). Children with minimal sensorineural hearing
loss: prevalence, educational performance, and functional status. Ear Hear 19(5), 339-354.
Bess, F.H., Gustafson, S.J., Corbett, B.A., Lambert, E.W., Camarata, S.M., & Horsnby, B.W.
(2016). Salivary cortisol profiles of children with hearing loss. Ear Hear 37(3), 334-344.
Gurney, J.G., Tersak, J.M., Ness, K.K., Landier, W., Matthay, K.K., Schmidt, M.L., & Children’s
Oncology Group. (2007). Hearing loss, quality of life, and academic problems in long-term
neuroblastoma survivors: a report from the Children’s Oncology Group. Pediatrics 120(5), 1229-
Hornsby, B.W.Y., Gustafson, S.J., Lancaster, H., Cho, S-J., Camarata, S., & Bess, F.H. (2017).
Subjective fatigue in children with hearing loss assessed using self- and parent-proxy report. Am
J Audiol 26, 393-407.
Roland, L., Fischer, C., Tran, K., Rachakonda, T., Kallogjeri, D., & Lieu, J. (2016). Quality of life in children with hearing impairment: systematic review and meta-analysis. Otolaryngol Head Neck
Surg 155(2), 208-219.
David Hicks, M.D.: Dr. Hicks directs business development at Turner Scientific, and has
significant training and experience in clinical treatment of ear disorders. Contact:
Jeremy Turner, Ph.D.: Dr. Turner is the founder and Chief Scientific Officer at Turner Scientific.
He completed his Ph.D. in auditory neuroscience, and has more than 22 years’ experience in
preclinical hearing loss, tinnitus, and ototoxicity research. Contact: