Sensorineural hearing loss after spine surgery treated with hyperbaric oxygen therapy: two case reports

Abstract

Acute idiopathic sudden sensorineural hearing loss (ISSNHL) following lumbar spinal surgery is an exceedingly rare phenomenon. This paper presents a case of ISSNHL presenting acutely after lumbar spine decompression and fusion treated with transtympanic steroids and hyperbaric oxygen (HBO2) therapy. It also presents the ironic case of SSNHL secondary to presumed viral pathology sustained by the patient’s operative surgeon who was treated with transtympanic steroids and HBO2 as well. Proposed etiologies of the patient’s ISSNHL include: hypo- tension, prone operative position, malfitted/malpositioned headrest, microemboli from a cell-saver, and nitrous oxide anesthesia. The role of systemic hypotension as an etiology of ISSNHL is discussed given the fact that there are no reported cases of ISSNHL in orthopedic procedures performed with permissive hypotension. The initiation of steroids and HBO2 therapy has been shown to be an effective treatment for ISSNHL when started within 14 days of symptom onset. HBO2 and transtympanic steroids were initiated 10 days earlier in the operative surgeon, which showed to be a better treatment modality compared to the postoperative patient. ISSNHL in the acute postoperative period of lumbar spinal fusion surgery presents a unique treatment dilemma because systemic steroids are routinely avoided over concerns of pseudarthrosis. Of the seven documented cases of ISSNHL following lumbar spine surgery, none underwent HBO2 as a treatment modality.

Bilateral Sensorineural Hearing Loss After General Anesthesia for Basilar Invagination with Atlantolaxial Dislocation: a case report

“…The timing of disease development is crucial to determining its causes. The literature research did not clearly describe the onset, which ranged from immediately postoperative to ten days following surgery (12). In this case, SNHL was seen in this patient 9 h after the operation.…”

“…LMR and immediate postoperative SNHL can also result during Valsalva maneuvers during surgery or awakening from anesthesia, forceful coughing, and emesis after extubation (7,10). The unique prone position of spinal surgery is also thought to be a cause of SNHL, as poor head positioning in the prone position can cause increased venous pressure, which worsens interstitial edema, compresses perforating vessels, and ultimately decreases tissue perfusion (11,12). However, nitrous oxide was not administered intraoperatively; no cerebrospinal uid was leaking, and high airway pressures did not injure the inner ear.…”

Unilateral sensorineural hearing loss after arthroscopic shoulder surgery in the beach-chair position: a case report

“… 19 2019 Posterior stabilization of T10-L1 for ankylosing spondylitis Yes Left Unknown No improvement L4-5 transforaminal lumbar interbody fusion Yes Left Unknown No improvement (IV steroids) Decompression and stabilization for tuberculous spondylodiskitis Yes Right Unknown No improvement Goodrich et al. 13 2018 Lumbar spine decompression (L2-5) and fusion (L3-5) Yes Right Hypotension, positioning, microemboli from the cell-saver, and nitrous oxide Hyperbaric O2 (mild right side improvement) Vilhena et al. 30 2016 Total knee arthroplasty No Bilateral (L>R) Spinal and epidural anesthesia : loss of CSF leads to drop in intracranial pressure transmitted to the inner ear perilymph via the cochlear aqueduct Hyperbaric O2 therapy: audiogram to 90% normal on left at follow-up Sahin et al.…”

“…28 Most of these cases in the orthopedic literature include patients with sudden hearing loss after spine surgery in the prone position. 5 , 12 , 13 , 18 , 19 , 23 , 28 However, reports also exist of hearing loss after surgery in patients in the supine position. 8 , 27 , 30 …”

Hyperbaric Oxygenation as Adjunctive Therapy in the Treatment of Sudden Sensorineural Hearing Loss

“…Based on recent evidence, addition of HBOT to corticosteroids may be beneficial only when initiated early. The most favorable prognoses concern SSNHL patients with a medium or deep level of hearing loss (>41 dB), for whom HBOT was implemented within 14 days of the occurrence of the hearing loss [ 19 , 37 , 40 , 41 , 42 , 47 , 48 , 49 , 51 , 52 , 53 ]. According to the EHMS recommendation, it would be reasonable to use HBOT as an adjunct to corticosteroids in patients presenting after the first two weeks but not later than one month, particularly in patients with severe and profound hearing loss [ 2 ].…”