Epidural anesthesia has significantly advanced in neuraxial anesthesia and analgesia. It is used for surgical anaesthesia and treatment of chronic pain. Hearing loss during or after epidural anesthesia is rare, and it is known to occur by the change of the intracranial pressure. Cerebrospinal fluid is connected with perilymph in the cochlear and vestibule that is important to hearing and balance. If the intracranial pressure is abruptly transferred to the inner ear, perilymph can be leak, that called perilymphatic fistula, dizziness, and hearing loss can occur suddenly. We report a 65-year-old woman who presented with acute onset dizziness and hearing loss during the epidural nerve block for back pain, wherein we speculated a possibility of perilymphatic fistula as the mechanism of hearing loss and dizziness. The mechanism of dizziness and hearing loss was suspected with perilymphatic fistula.
Postoperative vertigo can occur after stapes surgery in approximately 5% of the
patients, which more commonly presents immediately after surgery rather than
in the delayed period. Isolated delayed vertigo after stapes surgery is commonly
related to perilymphatic fistula. Herein we report a 36-year-old female patient
who developed positional vertigo 18 days after stapes surgery demonstrating severe
geotropic horizontal positional nystagmus on both sides during supine roll test.
This patient was eventually diagnosed as the horizontal semicircular canal benign
paroxysmal positional vertigo (BPPV) on the left side. This is a rare case of
delayed vertigo following stapes surgery caused by BPPV rather than perilymphatic
fistula.
Diagnosis of perilymphatic fistula (PLF) is considered in the patient presenting hearing loss associated with ataxia
after penetrating injury of the tympanic membrane. PLF accompanies mixed type hearing loss and paralytic nystagmus.
If audiovestibular symptoms and signs are not definite for those patients, in whom PLF is highly suspicious, they can
be induced by affected ear down position. The direction of nystagmus induced by position change was reported either
toward or away from the affected ear. But the direction changing nature has not been noted in the previous literature.
We report on a case of traumatic PLF presented with direction changing positional nystagmus and discuss the possible
mechanism involved in this case.
Key Words : Positional nystagmus, Perilymphatic fistula