[Cochlear implantation in patients with autoimmune hearing loss].

Abstract

Autoimmune inner ear disease (AIED) manifests with recurrent fluctuating sensorineural hearing loss and vestibular symptoms. Treatment includes steroids and avariety of immunosuppressants. Despite adequate treatment, sensorineural hearing loss can be progressive to the point of deafness. In these patients, acochlear implant (CI) is indicated. We present the case of a25-year-old male who underwent cochlear implantation in the left ear. After implantation we noticed brisk variations in impedances which were related to application of the previously prescribed tumor necrosis alpha (TNFα) inhibitor adalimumab. Can immunomodulatory therapy in AIED patients after CI fitting affect the quality of hearing rehabilitation? We documented impedances and speech intelligibility (Freiburg monosyllable test) of our patient for 1year in dependence on adalimumab therapy. Directly after implantation, impedances were within the normal range. During the further course, impedances started to rise, and recurrent adjustments of the implant were needed. Adalimumab therapy was reinitiated, which resulted in asubsequent reduction of impedances. Cochlear implantation can be necessary in some AIED patients and poses asufficient method for hearing rehabilitation. Depending on the activity of the underlying disease, arise in impedances may occur. Immunomodulatory treatment may therefore be necessary to maintain adequate hearing results with the CI.