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

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.

• Authors: Jamie A Schlacter, Emily Kay-Rivest, Sean O McMenomey, J Thomas Roland Jr, David R Friedmann, Daniel Jethanamest
• Journal: Cochlear implants international (Cochlear Implants Int) Vol. 24 Issue 5 Pg. 268-272 (09 2023) ISSN: 1754-7628 [Electronic] England
• PMID: 36988037 (Publication Type: Case Reports, Journal Article)

Chemical References

• Immune Checkpoint Inhibitors

Topics

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