Recurrent hearing loss after myelography treated with epidural blood patch

Sensorineural hearing loss following lumbar puncture, spinal anaesthesia or epidural anaesthesia: a case series and literature review

Background

Sensorineural hearing loss following spinal anaesthesia, epidural anaesthesia or lumbar puncture is a rare phenomenon that is thought to occur when reduced cerebrospinal fluid pressure is transmitted to the inner ear through an enlarged cochlear aqueduct.

Method

This study presents two cases of sensorineural hearing loss following spinal anaesthesia for caesarean section as well as presenting results of a systemic review of the available literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text articles from Medline, PubMed and Embase were used, as well as associated reference lists. Risk factors associated with poorer outcomes and an approach to management of this rare condition are also discussed.

Results

Twenty-one cases were identified. The literature was systematically reviewed showing presentations, investigations performed, treatments offered and outcomes.

Conclusion

Sensorineural hearing loss following spinal anaesthesia, epidural anaesthesia or lumbar puncture is a rare occurrence that requires a high degree of clinical suspicion and prompt investigation and treatment.

Transmission pathways of vibratory stimulation as measured by subjective thresholds and distortion-product otoacoustic emissions

To clarify the contribution of the skull contents to the transmission of bone vibratory stimuli, and to examine the characteristics of such stimuli, we compared auditory thresholds and distortion-product otoacoustic emission (DPOAE) levels with a bone vibrator placed on various sites of the head, including the eye. The best audiometric thresholds and the highest DPOAE levels were obtained with the vibrator placed on the mastoid of the measuring side, or on the "ultrasound-window" of the temple. The audiometric thresholds obtained with the bone vibrator on the eye were similar to those of the forehead, and about 10 dB higher than at the best sites. DPOAEs were clearly present when elicited by a combination of air-conducted stimuli presented through an insert earphone and with the bone vibrator placed on the eye. These results indicate that vibratory sounds can be transmitted through the skull contents to the inner ear. The intracranial transmission pathway of the vibratory stimuli may play a significant role, particularly at low frequencies, and possibly also when the vibratory stimuli are applied on the skull bone.

Unilateral hearing loss following shunt placement for normal pressure hydrocephalus with a unilateral patent cochlear aqueduct

Hearing loss in patients who have undergone shunt placement for a hydrocephalus is perhaps an underestimated complication rather than a rare event. There appears to be a correlation between the occurrence of hearing loss and patient characteristics consistent with excessive drainage of cerebrospinal fluid (CSF) and patent cochlear aqueduct (CA). We present the case of a 77-year-old man with unilateral dominant sensorineural hearing loss after a shunt placement for normal pressure hydrocephalus (NPH) combined with a patent cochlear aqueduct. Based on our experience and a review of the literature, we suggest an early restoration of the reduced CSF pressure using a programmable valve as a treatment strategy, which might prevent the persistent hearing loss.