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Sudden sensorineural hearing loss (SSNHL) after spinal-epidural anaesthesia is a very rare complication. The patient is a 25-year-old female who developed right-sided hearing loss, unbalance, a sensation of aural fullness and tinnitus 2 days post uncomplicated spinal-epidural anaesthesia for an emergency caesarean section. Initial management by her primary care physician for suspected eustachian tube dysfunction did not relieve symptoms, and 2 weeks subsequently, audiological assessment demonstrated right Sensorineural hearing loss (SNHL). Specialist consultation was sought, and the patient was commenced on systemic corticosteroids. Microscope otoscopy and posterior fossa magnetic resonance imaging were normal. High-resolution computed tomography scan demonstrated an enlarged right cochlear aqueduct. Repeat audiology after 2 weeks revealed unchanged hearing levels and improved speech discrimination scores in the right ear (from 53 to 90%). Repeat audiogram at 4 months and at 10 months showed no further improvement. Possible physiopathology of this complication, diagnostic dilemma and review of treatment options are discussed.

Background: Non-echo planar diffusion weighted MRI (NEDWI MRI) is accurate in detecting cholesteatoma in the post-operative ear but the effect on surgical decision-making in the setting of revision mastoid surgery using surgical histopathology as the gold standard has not been investigated. Methods: A blinded diagnostic accuracy study of pre-operative NEDWI MRI was conducted for consecutive patients requiring revision mastoid surgery. The operating surgeon completed a pre-operative survey without knowledge of the MRI results and post-operative survey after knowledge of the MRI results to determine impact on clinical decision making. Results: Non-EPI DWI MRI demonstrated overall sensitivity of 45.45% (95% CI: 16.75-76.62), specificity of 88.24% (95% CI: 63.56-98.54%), in detecting recurrent cholesteatoma in 28 operations. In 65.22% of cases the operating surgeon would have proceeded with second look surgery regardless of the MRI result. Conclusions: Negative NEDWI has the potential to reduce unnecessary surgery in patients who have no indication for surgery other than disease surveillance.

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.