IJCRR

IJCRR - 13(2), January, 2021

Pages: 26-28

Date of Publication: 16-Jan-2021

Transient Hearing Loss in Patients after Surgery Under Spinal Anaesthesia: A Tertiary Care Centre Based Study

Author: Aparna Girish Benare, Aditya Khot

Category: Healthcare

Abstract:Introduction: In most of the surgical interventions, spinal route of anaesthesia is the very frequent type of regional anaesthesia & it's been used for with minimal complications. But few cases report hearing loss post-spinal anaesthesia, mostly affecting the low range frequency. Objective: To study the post-spinal anaesthesia hearing loss observed in the patient at a tertiary care centre. Method: The current study was done in a total of 60 cases who went for surgical intervention under spinal anaesthesia. Informed written consent was obtained from each patient. The pre-anaesthetic check-up was done in all the cases. Audiometry was done in all the cases before surgery. Post-operative hearing loss was recorded on 2nd and 5th day after surgery. The audiogram was done again after 1 month of surgery to verify whether hearing loss is temporary or permanent. Also resulting complications if any have been recorded. Results: Maximum cases (40%) in our study were in the age group of 21-30 years followed by 31-40 years of age. Majority of them were male (60%) and 90% of patients were of the American Society of anaesthesiologists (ASA grade I. Temporary hearing loss was diagnosed in 13.33% cases. Post spinal headache was observed in 16.67% cases and post-spinal hypotension was observed in 23.33% cases. Two cases were having a hearing loss at 2000Hz while at 250Hz and 6000Hz one case each was diagnosed. This hearing loss was completely revered in one month. Conclusion: Transient hearing loss was diagnosed in 13.33% patients and it was found that hearing loss was completely reversible.

Keywords: Hearing loss, Spinal anaesthesia, Audiogram, Surgical intervention

Full Text:

INTRODUCTION

            In a tertiary care centre, many people undergo surgical intervention for some or the other reason. Every individual wants this experience to be painless both during the surgery & afterwards. Spinal anesthesia is the most commonly preferred method for its minimal complications^1,2. Its advantages are many like, its very cost effective technique, need for intubation is not there and hence in turn there is no risk of aspiration pneumonia due to gastric contents. But this procedure is for shorter duration only (upto two hours). Hearing loss after spinal anesthesia has been well known complication yet it’s infrequently documented & it affects mostly the lower frequency range^3,4.

            Such hearing disorders after spinal anesthesia is frequently linked with the “postspinal headache syndrome”. These clinical symptoms result from Cerebrospinal fluid (CSF) leakage via the spinal puncture hole. In turn, this CSF loss leads to a corresponding reduction in intracranial and intracochlear pressure. Spinal needle size can be associated with the occurrence of hearing loss. ^5-6 In addition, the auditory symptoms may be the result of drainage of inner ear fluid (perilymph) via the cochlear aqueduct that links CSF and cochlear fluids. Apart from that, there is a long list of post-surgical complications ranging from lumbar headache, vertigo, nausea, vomiting etc. Apart from spinal aneshtesis, there are many clinical scenarios where transient hearing loss can occur like myelography, acoustic neuroma surgeries, vp shunts, neurosurgeries etc^7-9.

Aims and Objective: To study the post spinal anesthesia hearing loss observed in patient at a tertiary care centre.

MATERIALS AND METHOD

Current study was performed at a tertiary care centre with following inclusion & exclusion criteria for selection of the study population:

Inclusion Criteria

• Patients admitted for various surgeries under spinal anesthesia.

• Patients from the age group of 20 to 60 years.

• Patients with Normal hearing power.

• Patients in ASA grade I or II classification.

Exclusion Criteria

• Patients not willing for Spinal anesthesia or nervous or very apprehensive patients

• Patients with pre-existing hearing impairment.

• Patients with ASA grade III or more.

            So finally, total 60 cases were selected for the study. Informed written consent was obtained from each patient. Pre-anesthetic examination was done in all the patients. Detailed physical examination was carried out. Spine was examined to see presence of any skin infection, deformity, calcification, movements and history of previous operation. Audiometry was performed in all the patients before surgery in a sound-proArphi portable audiometer. Post-operative hearing loss was recorded on 2^nd& 5^th day following surgery. The audiogram was repeated after one month post-surgery to verify if return of normal hearing power had occurred. The complications that have occurred had also been recorded. All the findings were recorded on a Preformed proforma.

RESULTS

It was observed that majority of the patients (40%) in our study were in the age range of 21 to 30 years followed by 31-40 years of age (26.67%). Majority of the patients were male (60%) and 90% patients were of ASA grade I.

The mean preoperative systolic blood pressure was 126.45±12.78 and mean post-operative systolic blood pressure was 114.65±12.38 mm of Hg. The mean pre and post operative diastolic blood pressure was 82.21±8.43 and 61.93±7.34 mm of Hg respectively.

Eight cases showed transient hearing loss, ten cases showed post spinal headache while fourteen cases had post spinal hypotension.

In our study, we have observed that, four cases were having hearing loss at 2000 Hz while at 250 Hz & 6000 Hz, two cases each were having hearing loss. All the cases were strictly followed for a month & we found out that, this hearing loss was completely reversed after one month.

DISCUSSION

            Current study was conducted at a tertiary care centre with the main objective was to study the post spinal anesthesia hearing loss observed in patients. We found out that the maximum cases in our study group were in the age group of 31-40 years (table no 1) & majority of them were males^10-11. Ninety percent of the cases were of ASA grade I. similar findings were observed by the previous studies. The average preoperative systolic blood Pressure (BP) was 126.45±12.78 & mean postoperative systolic BP was 114.65±12.38 mm of Hg. The average pre & post-operative diastolic BP was 82.21±8.43 & 61.93±7.34 mm of Hg (table no 2). Temporary hearing loss was diagnosed in 13.33% of the cases (table no 3).

            Lumbar headache after spinal anesthesia was seen in 16.67% of the cases whereas post spinal hypotension was seen in 23.33% of the cases. Sirsamkar in their study observed that 8% cases were suffering from temporary hearing loss. Whereas Lasisi¹² observed that bone conduction hearing impairment after spinal anesthesia was around 15%. In study conducted by Yildiz et al¹³, 7.5% of the study population reported the hearing impairment. In our research it was observed that four cases were having hearing loss at 2000Hz while at 250Hz and 6000Hz two cases each was diagnosed (table 4). All the study subjects were followed for a month and it was observed that the hearing loss was totally revered in one month. Bansode et al¹⁰ in their study observed significant hearing impairment in overall 7.7% of their study subjects after spinal anesthesia.

            In Group Y (young) of their study 2 patients (6.6%) developed significant hearing loss at 1000Hz. In groups M (middle-aged) 4 patients (13.3%) had significant hearing loss. One developed hearing loss at 125Hz while the other 3 patients had hearing loss at 6000Hz and 8000Hz (table 4). In group E (elderly) only one patient (3.3%) developed significant hearing loss at 250 Hz. L.P. Wang et al conducted the similar study and their findings are in agreement with our study findings.

            Many researchers have suggested that there a strong association between post dural puncture headache & this transient hearing loss^14-16. They say that both these conditions i.e post dural puncture headache & transient hearing loss have the same mechanism which is drop in intracranial tension due to Cerebrospinal fluid  (CSF) leak. Hughson et al¹⁷ says that drop in CSF pressure predisposes to the decrease in intralabyrinthine pressure which ultimately results in transient hearing loss.

CONCLUSION

From the observations of our study we can conclude that transient hearing loss was diagnosed in 13.33% patients and it was found that hearing loss was completely reversible. And strong association between post dural puncture headache & this transient hearing loss.

Acknowledgement

Ethical clearance- Taken from institutional ethics committee.

Conflict of Interest: Nil

Source of Funding: Nil

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