Metastatic lung adenocarcinoma causing sudden hearing loss and vertigo

What happened, in summary

A 69-year-old woman developed 2 weeks of left-sided hearing loss and progressively worsening vertigo. Ten months earlier, she had been diagnosed with lung adenocarcinoma that had spread to the bones, liver and brain, making this Stage IV disease. Her cancer had been managed with nivolumab immunotherapy, steroids and palliative radiotherapy.

During the new episode, examination showed right-beating nystagmus and mild left facial nerve weakness. Hearing testing confirmed new deafness in the left ear compared with a test performed 8 months earlier. The combination of rapidly progressive hearing loss, vertigo and facial weakness was linked to metastatic involvement of the internal auditory meatus, an uncommon site close to the hearing and facial nerves.

The new metastatic involvement represented another setback in an already widespread lung-cancer course. At this point, she had progressive metastatic disease involving multiple distant sites together with new neurologic and ear-related symptoms.