Bilateral cochlear implantation after immunotherapy-related profound hearing loss: A case report

Cochlear Implants Int. 2023 Sep;24(5):268-272. doi: 10.1080/14670100.2023.2193918. Epub 2023 Mar 29.

Abstract

Objectives: Immune-checkpoint inhibitors (ICI) are being utilized with increasing frequency and may be linked to neurologic and audiovestibular toxicities. This report aimed to describe a case of ICI-induced sensorineural hearing loss ultimately requiring bilateral cochlear implantation.

Methods: A 42-year-old female with stage IV metastatic melanoma of the perianal skin was treated with ipilimumab (blocker of cytotoxic T-lymphocyte associated protein 4 [CTLA-4]) and nivolumab (anti-programmed cell death protein 1 [PD1]). After 21 weeks of therapy, she developed sudden vertigo and bilateral hearing loss. A full workup including MRI and lumbar puncture ruled out intracranial parenchymal metastases, leptomeningeal metastases, stroke and intracranial infection. ICI-associated aseptic meningoencephalitis was therefore diagnosed. The patient received systemic steroids as well as intratympanic steroids, which temporarily improved hearing, but eventually developed permanent, bilateral profound sensorineural hearing loss.

Results: The patient received bilateral cochlear implants and has demonstrated good performance one year after implantation.

Discussion: ICI are being increasingly used to treat a variety of advanced malignancies. This is the first report of bilateral cochlear implants in the context of profound hearing loss after an immunotherapy induced meningoencephalitis.

Conclusion: ICI carries the risk of potential ototoxicity, including profound SNHL as depicted in our case. Cochlear implantation proved to be beneficial and may be considered in patients with ICI-related hearing loss.

Keywords: Cochlear implants; Hearing loss; Immunotherapy; Malignancy; Ototoxicity.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cochlear Implantation*
  • Cochlear Implants
  • Female
  • Hearing Loss, Sensorineural* / chemically induced
  • Hearing Loss, Sensorineural* / surgery
  • Humans
  • Immune Checkpoint Inhibitors* / adverse effects
  • Immunotherapy* / adverse effects
  • Treatment Outcome

Substances

  • Immune Checkpoint Inhibitors