Viale M, Narchi P, Veyrac P, Benhamou D
Chirurgie ORL, Clinique Sainte Croix, Le Mans.
Ann Otolaryngol Chir Cervicofac. 1996;113(3):175-7.
Hearing loss and tinnitus are frequently encountered in ENT patients and usually require complementary investigations such as audiogram, auditive evoked potentials, CT scan, MRI... One recent etiology, that is more and more discovered, is a decrease in spinal fluid pressure secondary to a dural fluid leak that occurs after a diagnostic lumbar puncture, a spinal anesthesia, an accidental dural puncture during an epidural technique or a lumbar myelography. Postural headache which are frequently present in such a setting, may mask these auditive symptoms. Epidural injection of autologous blood (blood patch) performed by anesthesiologists, which is usually indicated to treat such postural headaches, is efficient in relieving other symptoms related to spinal fluid leak after dural puncture. We report two cases of isolated auditive complaints (hearing loss and tinnitus) which have been dramatically improved after blood patch. In conclusion, ENT surgeons should seek for a recent or even a past history of spinal puncture whenever the etiology of auditive symptoms of their patient remains unclear.
听力损失和耳鸣在耳鼻喉科患者中经常出现，通常需要进行辅助检查，如听力图、听觉诱发电位、CT扫描、MRI……最近越来越多地发现一种病因，即诊断性腰椎穿刺、脊髓麻醉、硬膜外技术过程中的意外硬膜穿刺或腰椎脊髓造影后发生硬膜液漏导致脑脊液压力降低。在这种情况下经常出现的体位性头痛可能会掩盖这些听觉症状。麻醉医生进行的自体血硬膜外注射（血补丁）通常用于治疗此类体位性头痛，对缓解硬膜穿刺后与脑脊液漏相关的其他症状有效。我们报告了两例孤立性听觉主诉（听力损失和耳鸣）患者，在进行血补丁治疗后症状得到显著改善。总之，当耳鼻喉科医生患者的听觉症状病因不明时，应询问其近期甚至既往的腰椎穿刺史。
