Chronic Myeloid Leukemia (CML) with Permanent Hearing Loss

Abstract

Objective: The present case study aims to discuss a rare case of chronic myeloid leukemia causing bilateral hearing impairment, tinnitus, and vertigo. Introduction: Chronic Myeloid Leukemia (CML) or chronic granulocytic leukemia is a type of blood cancer that affects the bone marrow. It results in an overproduction of immature White Blood Cells (WBCs) that typically happens throughout or after middle age, and adolescents are rarely affected. The genetic mutation that causes CML is known as the BCR-ABL fusion gene. Case Presentation: In this case report, a 30-year-old female presented to the hospital of Jazan, Saudi Arabia, with sudden hearing impairment and other symptoms, leading to a CML diagnosis. The patient had no prior hearing impairment background, and the otoscopic scanning was normal. The Pure Tone Audiometry (PTA) showed profound sensorineural hearing loss on both sides. Blood tests revealed hyperleukocytosis with marked neutrophilia, mild basophilia, and eosinophilia and a BCR-ABL quantitation of 85%. Bone marrow aspiration showed granulocytic hyperplasia, mild left-shifted maturation, and less than 1% blasts. Results: The patient was started with options including Tyrosine Kinase Inhibitors (TKIs) such as Imatinib, which target the BCR-ABL fusion gene, reducing the number of leukemia cells and improving her white blood cell count. However, her deafness persisted, and she became dependent on hearing aids. Discussion: CML presenting with hearing loss is rare, with only a few reported cases in the literature. It is believed to be related to the infiltration of leukemic cells in the inner ear or the microvascular complications associated with the disease. Hearing loss can be reversible or permanent, depending on the severity and duration of the disease. Treatment of CML with tyrosine kinase inhibitors such as Imatinib can improve the hematologic parameters, but the effect on hearing loss is uncertain.