The effect of different anaesthetic agents in hearing loss following spinal anaesthesia

Sensorineural hearing changes after myelogram

Dire consequences can occur after any medical or surgical procedure. Certain procedures may even cause sensorineural hearing loss (SNHL). Previous studies have demonstrated that certain surgical and medical procedures may result in hearing losses of varying degrees. Although hearing loss is a well-known phenomenon, little consistent information exists about hearing loss after medical or surgical procedures. This one-tailed, directional study compared the effect of myelogram procedures on hearing in selected outpatients. A pre/posttest design was used to measure audiograms in 27 myelogram subjects. Pre- and postprocedure hearing tests were measured by audiometry and compared for differences. Results did not support previous studies that low-frequency hearing loss can occur within 24 hours after myelogram procedure. Clinically relevant information was found in one subject 53 hours post myelogram.

Cauda Equina Syndrome and Profound Hearing Loss After Spinal Anesthesia with Isobaric Bupivacaine

A 33-yr-old man undergoing anorectal surgery developed cauda equina syndrome and bilateral profound hearing loss after single-injection spinal anesthesia with isobaric bupivacaine. There was no pain on needle placement. Neurologic assessment found impaired sensation to pinprick in the perineal region, lower extremity paralysis, and bowel and bladder incontinence. In addition, he developed a bilateral profound hearing loss involving the low frequencies, with the left side more affected than the right side. Although hearing impairment can occur with cerebrospinal fluid leakage, the etiology of cauda equina syndrome is uncertain. The simultaneous occurrence of these events has not been previously reported.

The effect of combined spinal-epidural (CSE) anaesthesia and size of spinal needle on postoperative hearing loss after elective caesarean section

The exact aetiology of vestibulocochlear dysfunction after spinal anaesthesia is unknown. Low-frequency hearing loss occurs after spinal anaesthesia. The aim of this study was to investigate the effects of combined spinal-epidural (CSE) anaesthesia and size of spinal needle on vestibulocochlear dysfunction, using pure tone audiometry performed pre- and on the first and the second day postoperatively. Forty-five patients who were to undergo elective caesarean section were evaluated. In group I, CSE anaesthesia (18 G Tuohy, 25 G Whitacre pencil-point-design spinal needles) was performed in 15 patients. In group II, spinal anaesthesia was performed in 15 patients with 25 G Whitacre pencil-point-design spinal needles and, in group III, spinal anaesthesia was performed in 15 patients with 22 G Whitacre pencil-point-design spinal needles. In the pre- and on the first and the second day postoperatively, the pure tone audiogram was performed in the audiology laboratory of our hospital, using a calibrated Kamplex Diagnostic Audiometer AC 40 in a noise-free room. When the CSE anaesthesia group and 22 G spinal group were compared for change in hearing between the pre- and postoperative periods, a statistically significant difference was observed at R-right ear 125 Hz (P < 0.025) and at L-left ear 125 Hz (P < 0.023), and at L-left ear 1000 Hz (P < 0.036) and at R-right ear 1500 Hz (P < 0.006), and at L-left ear 1500 Hz (P < 0.022). At other frequencies, the difference was insignificant. When the CSE anaesthesia group and 25 G spinal group were compared for change in hearing between the pre- and postoperative periods, no statistically significant difference was detected at any frequency tested. When 22 G spinal group and 25 G spinal group were compared for change in hearing between the pre- and postoperative periods, there was some hearing loss at low frequency, although this difference did not reach statistical significance. The positive correlation of low-frequency hearing loss and increased pressure in the epidural space (which decrease the risk of cerebrospinal fluid leakage through the dura) suggests that cerebrospinal fluid leakage via the spinal puncture hole is not the only factor involved. Perioperative fluid replacement alone may not prevent hearing loss but CSF loss through the dural puncture site should also be prevented.

Sensorineural hearing loss after select procedures

Hearing is one of the most significant senses; therefore, any loss can be frightening. Previous studies have found that certain surgical and medical procedures can result in hearing loss. Cardiac surgical procedures are most commonly associated with hearing loss owing to the use of the cardiopulmonary bypass pump. Other noncardiac, nonotologic surgical procedures also may result in hearing loss. Additionally, medical procedures such as myelogram and lumbar puncture have been associated with hearing loss. Studies suggest that hearing loss can result any time cerebrospinal fluid is leaked. This report highlights the effect of dural puncture on hearing loss. The implication that any dural puncture procedure may result in a cerebrospinal fluid leak and subsequent hearing loss is a significant clinical topic. Perianesthesia nurses are advised to educate themselves and their patients regarding this complication.