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117 Is there a perfect spinal? A case of sensorineural hearing loss
  1. ARSA Silva,
  2. TRA Martins,
  3. LAM Ledo and
  4. MPS Lucas
  1. Hospital Garcia de Orta, Almada, Portugal


Background and Aims Spinal anaesthesia (SA) is considered a safe technique even if associated with several complications. Reduced CSF pressure from leakage trough dural puncture site has been associated with post-dural puncture headache (PDPH) and is a proposed mechanism for sensorineural hearing loss (SNHL). Presumably, reduced CSF pressure transmits to inner ear impeding auditory hair cells function. Data reports 0,4% incidence with some cases of persisting SNHL and correlates with large gauge and cutting point needles utilization. Blood patch, steroid therapy, hyperbaric oxygen and supportive measures are among treatment options with good outcome. We aim to point out a case of isolated SNHL after uneventful SA in a healthy young woman.

Methods 42y healthy woman with uncomplicated pregnancy admitted for elective C-Section at term. SA was successful at first attempt with a 27G pencil point needle inserted on L3-L4 space. Bupivacaine 7,5 mg plus sufentanyl 2,5μg were administered after backflow of CSF.

Results No complications were recorded on perioperative period. After 3 days, isolated sudden left SNHL occurred upon standing. Otolaryngologic evaluation showed isolated low frequency left SNHL. Vigorous hydration and restricted supine position resulted in rapid improvement. Audiogram confirmed absence of SNHL at discharged on day 7.

Conclusions SNHL may occur despite an uneventful SA. Improvement after implemented measures reinforces the above-mentioned hypothesis as probable underlaying physiological mechanism. Supportive treatment can be successful managing isolated SNHL. Because there is a risk of permanent damage, a high suspicion index for SNHL should be present even in the absence of PDPH to warrant an early diagnosis.

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