Park Paul, Toung James S, Smythe Paul, Telian Steven A, La Marca Frank
Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI 48109, USA.
Surg Neurol. 2006 Oct;66(4):415-8; discussion 418-9. doi: 10.1016/j.surneu.2005.12.026.
Sudden sensorineural hearing loss is infrequent, with an estimated incidence of 5 to 20 cases yearly per 100,000 people. Although multiple etiologies have been identified, infection and idiopathic SNHL are most common. Sudden sensorineural hearing loss after nonotologic noncardiac surgery is highly unusual, particularly after spinal surgery.
We report a case of unilateral sudden SNHL after lumbar spinal fusion with review of the literature. Potential etiologies, treatment, and prognosis are summarized.
Multiple etiologies have been proposed for SNHL after nonotologic noncardiac surgery. Excessive positive upper airway pressure during induction of anesthesia or Valsalva maneuvers can result in SNHL from LMR. Aberrant NO accumulation in the middle ear cavity during general anesthesia with subsequent LMR is also a potential etiology, as is excessive leakage of CSF causing a form of endolymphatic hydrops. There is no definitive treatment of postoperative SNHL, although middle ear exploration may be beneficial for suspected overpressure injury to the middle ear, causing a perilymphatic fistula. Corticosteroids have been beneficial in certain cases of idiopathic SNHL; however, its effectiveness for postoperative SNHL is undocumented.
突发性感音神经性听力损失并不常见，估计每年每10万人中有5至20例发病。尽管已确定多种病因，但感染和特发性突发性感音神经性听力损失最为常见。非耳科非心脏手术后发生突发性感音神经性听力损失非常罕见，尤其是在脊柱手术后。
我们报告一例腰椎融合术后单侧突发性感音神经性听力损失病例，并对文献进行回顾。总结了潜在病因、治疗方法和预后情况。
对于非耳科非心脏手术后的突发性感音神经性听力损失，已提出多种病因。麻醉诱导期间或瓦尔萨尔瓦动作时过高的上气道正压可因镫骨肌反射导致突发性感音神经性听力损失。全身麻醉期间中耳腔内一氧化氮异常积聚并随后引发镫骨肌反射也是一种潜在病因，脑脊液过度渗漏导致某种形式的内淋巴积水也是如此。术后突发性感音神经性听力损失尚无确切的治疗方法，不过中耳探查对于怀疑中耳受到过压损伤导致外淋巴瘘可能有益。皮质类固醇在某些特发性突发性感音神经性听力损失病例中已显示有益；然而，其对术后突发性感音神经性听力损失的有效性尚无文献记载。
