Children undergoing treatment for cancer often receive agents that put them at risk for ototoxicity. Platinum-based chemotherapy, aminoglycoside antibiotics, loop diuretics, and radiotherapy are all capable of inducing inner ear damage, which may result in significant sensorineural hearing loss. Frequent audiological monitoring is necessary for the early detection of changes in hearing thresholds. Age-appropriate modification of audiological testing is essential to obtain accurate results and provide maximum comfort for pediatric patients. When hearing loss is identified promptly, consideration may be given to treatment modification and/or early intervention with hearing aids and other assistive devices. The consequences of hearing loss differ depending on the developmental stage of the child at the time that hearing loss occurs. Language acquisition may be affected in very young children, whereas educational and psychosocial concerns are paramount for the older child. The pediatric oncology nurse is instrumental in assisting the child and family who are coping with hearing loss related to cancer treatment.