From thunder to silence: Cochlear implantation for bilateral profound sensorineural hearing loss after lightning strike.

INTRODUCTION: Lightning strikes can cause diverse neuro-otologic injuries. Tympanic membrane rupture is common, whereas bilateral profound sensorineural hearing loss with vestibular dysfunction and perilymphatic fistula is rare. Cochlear implantation for lightning-induced deafness has been reported only once. A farm worker struck by lightning sustained second-degree burns and intracranial hemorrhages requiring emergency neurosurgical management and cervical wound closure. During intensive care, clear left-sided otorrhea prompted ENT evaluation, revealing bilateral tympanic membrane perforations. Beta-trace testing confirmed cerebrospinal fluid leakage. Temporal bone CT demonstrated left ossicular chain dislocation and stapes footplate fracture with perilymphatic fistula, managed by exploratory tympanotomy with fistula closure and tympanic reconstruction. The patient remained with bilateral profound sensorineural hearing loss and left vestibular hypofunction. Six months after injury, right-sided cochlear implantation with a MED-EL Synchrony Flex 28 electrode array was performed. Four months post-implantation, aided thresholds averaged 30 dB HL with 30%-word recognition score at 65 dB SPL. Finally, 14 months after the trauma, left-sided cochlear implantation using the same model was undertaken. Although auditory recovery was slower than on the right side, the patient achieved open-set disyllabic word recognition score of 30% at 65 dB SPL by 3 months post-implantation. DISCUSSION: This case highlights the destructive potential of lightning on the auditory and vestibular systems and demonstrates that cochlear implantation can provide effective auditory rehabilitation when cochlear patency is preserved.