///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

UNINTENTIONAL DURAL PUNCTURE WITH EPIDURAL NEEDLE INDUCES LOW-FREQUENCY HEARING LOSS IN OBSTETRIC PATIENTS

Abstract Number: 47
Abstract Type: Original Research

Subrata Chakravarty MD1 ; Jose C.A. Carvalho MD2; Jerry Chapnik MD3; Mrinalini Balki MD4

Introduction

The reported incidence of transient low frequency hearing loss after spinal varies from 0.4-92%. The only study, which looked at hearing loss after unintentional dural punctures with epidural needle in nonobstetric patients, reported an incidence of 50% with significant improvement in hearing after epidural blood patch (EBP). It is unknown if such hearing loss occurs in obstetric population. This study was designed to study the frequency, severity and recovery of auditory complications following unintentional dural punctures in obstetric patients, as well as the role of EBP in such outcome.

Methods

After REB approval, 15 obstetric patients requiring labor analgesia, who had unintentional dural puncture with a 17G Touhy needle, were recruited into the study (planned n=50). Patients were assessed for headache, auditory, visual and musculoskeletal symptoms, and those not responding to conservative management were offered EBP. Audiometry was done within 24-72h after the dural puncture, after the EBP and after 1 mn.

Results

The mean age, height, and weight of patients were 343yrs, 1587cm and 7410kg respectively. Headache was reported by all the patients; it was moderate to severe in 73.3% patients, being maximum on day 3 (VAS 4.23). EBP was performed in 33.3% patients. Vestibular (nausea, vomiting, dizziness) and cochlear symptoms (hearing loss, plugging, tinnitus, ear pain) were reported by 8 and 4 patients respectively. One patient had accommodation problems and blurry vision, while 11 patients had musculoskeletal symptoms (neck stiffness and scapular pain). The results of initial audiometry test are shown in the Figure. Mild (15-25db) to moderate (26-40db) hearing loss at low frequency (250Hz) was seen in 60% patients. One patient showed remarkable improvement in audiometry results after EBP. Audiometry after EBP, and after 1 month was done in 12% and 25% of patients respectively. The audiometry results did not show any change after 1mn follow up.

Conclusion

We conclude that hearing loss at low frequency is common in the obstetric population after unintentional dural punctures with epidural needles; however, we were unable to identify this complication until audiometry was introduced into our service. We believe that upon completion of study, we will be able to determine the clinical significance of audiometry and potential benefits of an EBP for early recovery of such patients.

Reg Anesth 1996;21:197;Anesthesia 2006;61:98



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