Background/Objectives: Nasopharyngeal cancer (NPC) is prevalent in Southeast Asia, Southern China and North Africa. Up to 46% of NPC patients undergoing cisplatin chemoradiation treatment experience irreversible hearing loss. Prestin is a motor protein in the outer hair cells of the cochlea, and animal studies have shown that blood prestin levels are elevated following cisplatin induced hearing loss. We investigated whether rising serum prestin levels can predict sensorineural hearing loss (SHNL) in NPC patients undergoing induction cisplatin chemotherapy (icCRT). Methods: Serum prestin levels were measured at ten time points during cisplatin chemotherapy. Pure tone audiogram and tinnitus handicap inventory (THI) were measured at baseline and at one and nine months after cisplatin administration. These outcomes were obtained to investigate whether rising prestin levels predict SNHL or worsening THI. Results: Of the 11 patients accrued, there was no association between prestin level and SNHL. An increase in THI was associated with higher prestin levels. There was significant hearing loss at 8 kHz at one (right ear, p = 0.012, left ear, p = 0.043) and nine months (right ear, p = 0.011) after treatment. After completing cisplatin, patients also had increased THI. Conclusions: Prestin was not identified as a biomarker of cisplatin-induced hearing loss in our cohort of NPC patients undergoing icCRT. NPC patients experience worsening of tinnitus with cumulative cisplatin, and hearing loss can persist at nine months post treatment. Future studies should focus on improved novel methods for measuring prestin or other cochlear proteins to better identify potential markers before permanent cisplatin induced hearing loss.