PP801 - Cochlear Implantation Due to Multisystem Inflammation Syndrome Following COVID-19 Vaccination

Abstract:
Complications of the Covid-19 vaccines are increasingly being reported. Sequential bilateral cochlear implantation was performed in an individual who experienced bilateral profound hearing loss as a consequence of multisystem inflammation syndrome-vaccine (MIS-V). The hearing results were excellent bilaterally, likely due to the short duration of deafness and mechanism of injury. Results of the AzBio in noise are 95% correct in the right and 83% correct in the left. Cochlear implantation following hearing loss due to Covid-19 related MIS-V appears to be successful, albeit in a single case report.

Summary:
The United States Food and Drug Administration (FDA) approved the use of two COVID-19 vaccines, the BMT162b2 mRNA vaccine and the mRNA-1273 vaccine which have been shown to promote a type-1 interferon innate immune response to allow for adaptive immunity. To our knowledge, this is the first reported case of bilateral sensorineural hearing loss after the administration of the BMT162b2 mRNA vaccine.

Sensorineural hearing loss has been associated with many causes such as noise exposure, ototoxic drugs, genetic defects, infection, and aging. The levels of Cytokine CXCL9 were considerably elevated in our patient following his first COVID-19 vaccination pointing to a possible interferonopathy as the susceptibility factor allowing for a massive inflammatory response to the BMT162b2 mRNA vaccine. Despite aggressive steroid treatment, he sustained bilateral profound hearing loss without benefit from amplification.

The patient was cleared medically for cochlear implant surgery. Cochlear implant candidacy testing was performed. Otoscopy was unremarkable and the patient had Type A tympanograms bilaterally. Unaided testing showed no responses to pure tones or speech testing at the limits of the audiometer. High-powered hearing aids were programmed for AzBio testing and the patient scored 0% correct in quiet, bilaterally. Bilateral sequential implantation was performed given the uncertainty of performance as the etiology of the hearing loss was unknown. The rapid hearing improvement of the first implant led to the second side being implanted shortly after, also with quick success.

The following results were obtained 13 months post activation in the right ear and 7 months in the left ear. Testing of performance was obtained in the unilateral aided condition in sound field. Results with the AzBio for the right ear are 87.60% correct in quiet and 94.48% and with noise. In the left ear, results indicate 89.94% correct in quiet and 82.88% correct in noise. Moreover, aided testing in sound field was performed to obtain additional measures of patient performance. The patient had normal to mild responses to warbled tones from 250 Hz to 6000 Hz. Additionally, an SRT of 25 dB was obtained bilaterally with a PTA of 23.33 for the left processor and 26.67 for the right, indicating good reliability. Datalogging in the most recent appointment is approximately 14 hours per day on average.

Hearing results indicate the patient is doing very well. The patient self-reports that he is able to have conversations with little difficulty, even while on the phone. Neural response telemetry recordings remain stable, and programming remains within the standard parameters: ACE Strategy, MP1+ 2 mode, 900 Hz stimulation rate, 25 pulse width, and with 8 maxima. No electrodes have been shut off. Dynamic range continues to be supported at 45 to 48 clinical units.