Transient hearing loss after accidental dural puncture in epidural block

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.

Permanent hearing loss and tinnitus following epidural analgesia complicated by accidental dural puncture

We report a case of permanent high-frequency hearing loss and tinnitus in a 38-year-old woman following an unrecognised dural puncture during epidural placement. The patient reported subjective unilateral hearing loss and tinnitus, along with a post-dural puncture headache, four hours post-delivery. The patient's headache resolved following two epidural blood patches, however, hearing loss and tinnitus persisted longer than two years. Long-term auditory symptoms following epidural analgesia in labour are very unusual findings.

The influence of epidural anesthesia on the hearing system after normal labor

OBJECTIVE

The purpose of our study was to evaluate the influence of epidural anesthesia on the hearing system in women undergoing normal labor.

DESIGN

We examined two groups of patients: women with epidural anesthesia underwent four tests of distortion product otoacoustic emissions(DPOAEs): on admission, and fifteen minutes, one hour, and three hours after the last epidural bolus of local anesthetic. Auditory brainstem response (ABR) tests were performed on admission, and one hour, and three hours after the last epidural bolus. Women who gave birth without epidural anesthesia underwent DPOAEs tests on admission, during a uterine contraction, during active delivery, and three hours after labor. ABR tests were performed on admission, during a uterine contraction, and three hours after labor.

STUDY SAMPLE

twenty patients participated in the study. Twelve gave birth with epidural anesthesia and eight without anesthesia.

RESULTS

No significant changes in DPOAEs and ABR recordings were found between the two groups.

CONCLUSIONS

Epidural anesthesia does not impair the sensory or the neural elements of the hearing system and therefore does not influence hearing.