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

IF 1.4 Q2 OTORHINOLARYNGOLOGY

COCHLEAR IMPLANTS INTERNATIONAL Pub Date : 2023-09-01 Epub Date: 2023-03-29 DOI:10.1080/14670100.2023.2193918

Jamie A Schlacter, Emily Kay-Rivest, Sean O McMenomey, J Thomas Roland, David R Friedmann, Daniel Jethanamest

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引用次数: 0

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.

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免疫治疗相关深度听力损失后双侧人工耳蜗植入：一例报告。

目的：免疫检查点抑制剂（ICI）的使用频率越来越高，可能与神经和听前庭毒性有关。本报告旨在描述一例ICI诱导的感音神经性听力损失，最终需要双侧耳蜗植入。方法：对一名42岁的女性肛周皮肤IV期转移性黑色素瘤患者进行了ipilimumab（细胞毒性T淋巴细胞相关蛋白4的阻断剂[CTLA-4]）和nivolumab（抗程序性细胞死亡蛋白1[PD1]）治疗。经过21周的治疗，她突然出现眩晕和双侧听力损失。包括MRI和腰椎穿刺在内的全面检查排除了颅内实质转移、软脑膜转移、中风和颅内感染。因此诊断为ICI相关的无菌性脑膜脑炎。患者接受了全身性类固醇和鼓室内类固醇治疗，这暂时改善了听力，但最终出现了永久性的双侧深部感音神经性听力损失。结果：患者接受了双侧人工耳蜗植入，植入一年后表现良好。讨论：ICI正越来越多地用于治疗各种晚期恶性肿瘤。这是首次报道在免疫疗法诱导的脑膜脑炎后出现严重听力损失的情况下进行双侧人工耳蜗植入。结论：ICI具有潜在的耳毒性风险，包括我们病例中所描述的严重SNHL。人工耳蜗植入被证明是有益的，可以考虑用于ICI相关听力损失的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

COCHLEAR IMPLANTS INTERNATIONAL Medicine-Otorhinolaryngology

CiteScore

3.10

自引率

0.00%

发文量

期刊介绍： Cochlear Implants International was founded as an interdisciplinary, peer-reviewed journal in response to the growing number of publications in the field of cochlear implants. It was designed to meet a need to include scientific contributions from all the disciplines that are represented in cochlear implant teams: audiology, medicine and surgery, speech therapy and speech pathology, psychology, hearing therapy, radiology, pathology, engineering and acoustics, teaching, and communication. The aim was to found a truly interdisciplinary journal, representing the full breadth of the field of cochlear implantation.