Only a few case reports have been published about hearing impairment following lumbar puncture, and not all were thoroughly documented by audiograms. We present nine cases of hearing loss following myelography, lumbar puncture, and spinal anesthesia. We speculate that this rare complication arises only in persons with a wholly or partially patent cochlear aqueduct, and occurs via the release of perilymphatic fluid in the cerebrospinal space. Hearing loss was seen in eight of the nine patients in the lower frequencies, and in six of the nine patients on both sides. Recovery to normal hearing was noticed in six of the nine patients. Transient hearing loss may occur more often than it is generally assumed, and the symptom can remain unnoticed. Since not all of these hearing losses proved to be fully reversible, we suggest informing patients about this complication for medicolegal reasons.

When following the recommended protective measures the potential risk of infection is estimated as very low for surgeons and nurses. The risk of exposition seems to be higher in gynecological interventions than in ENT because of the much larger tissue masses and because laser plume escapes easier into the room air when applying an open approach.

No abstract

The postoperative pain and stress experienced by tonsillectomy patients are often underestimated. For this reason traditional methods of analgesia are frequently used but with an ineffective result. Our study involved an analysis of pain sensation with regard to postoperative analgesia after adult tonsillectomies. In all, 150 patients following tonsillectomy were treated with different methods of analgesia, which included Diclofenac monotherapy and combined treatment with Tramadol-retard and Naproxen. Postoperative sensations of pain were realized in a visual analogous pain score, with consideration given to individual experiences of subjective pain. In addition, circulatory and hemopoiesis parameters were controlled. Results showed that the postoperative analgesic effect of Diclofenac was significantly less than that of Tramadol-retard and Naproxen. Diclofenac monotherapy after tonsillectomy was only sufficient in cases involving an individual's low pain sensation. In cases with moderate or stronger pain the tonsillectomy patient requires an effective postoperative analgesia, as achieved with combined therapy using Tramadol retard and Naproxen. Aggravating side effects were not found in both schemes of analgesia.

Lesions of the lingual nerve and the glossopharyngeal nerve following tonsillectomy are rare but can be expected because of their anatomical course. What is extremely rare is a lesion of the hypoglossal nerve, whose course behind the carotid artery protects it from direct injury. The few cases described in the literature are thought to have been caused by inflammatory processes. It became necessary to look for other causes when, after a regular tonsillectomy, a hypoglossal palsy became evident in the absence of any inflammation. In an experiment, it was possible to demonstrate that both the insertion of a spatula and of an intubation spatula caused a strain of the hypoglossal nerve when the spatulas were inserted in the lateral lingual region. The nerve was distended by as much as 1.3 cm. The more the head was reclined, the more the nerve was distended. It would seem probable that this extension of the hypoglossal nerve causes its palsy following tonsillectomy.