gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Extreme sensitivity of hearing to decreases of intracranial pressure in Menière’s disease

Meeting Abstract

  • A. Kurzbuch - HUG - Hôpitaux Universitaires de Genève, Département Neurosciences Cliniques, Service de Neurochirurgie, Genève, Suisse
  • A. Momjian - HUG - Hôpitaux Universitaires de Genève, Département de Chirurgie, Service de Chirurgie maxillo-faciale et de chirurgie buccale, Genève, Suisse
  • K. Nicoucar - HUG - Hôpitaux Universitaires de Genève, Département Neurosciences Cliniques, Service d'ORL et de chirurgie cervico-faciale, Genève, Suisse
  • S. Momjian - HUG - Hôpitaux Universitaires de Genève, Département Neurosciences Cliniques, Service de Neurochirurgie, Genève, Suisse

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP16-05

DOI: 10.3205/09dgnc426, URN: urn:nbn:de:0183-09dgnc4267

Published: May 20, 2009

© 2009 Kurzbuch et al.
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Outline

Text

Objective: Hearing impairment has been described after ventriculo-peritoneal (VP) shunting. This report details the authors’ experience with a Menière’s disease patient affected by normal pressure hydrocephalus (NPH) who presented a cerebrospinal fluid (CSF) pressure dependent hearing impairment after ventriculo-peritoneal shunting.

Methods: The authors report the case of a 55-year-old female patient who had been suffering from Menière’s disease for 12 years and from NPH for 3 years when she underwent VP shunting with the placement of a programmable valve.

Results: Subsequent to VP shunt insertion for NPH, the patient presented a non-postural bilateral hearing impairment. The manifestation and resolution of the latter was dependent on the opening pressure value of the implanted programmable valve. The striking particularity of this case was that the hearing deficit appeared and disappeared in the high opening pressures range a minute after change of the valve setting.

Conclusions: Hearing in Menière’s disease patients may be extremely sensitive to CSF pressure decreases, notably after VP shunting. This observation should render neurosurgeons aware of this disabling side-effect when considering shunting in patients with pre-existing Menière’s disease and, consequently, these patients should be informed of this potential risk. Indeed, this side effect may considerably compromise the efficacy of the shunt against NPH symptoms and renders NPH treatment difficult. As the hearing impairment could be reversed by slightly raising the CSF pressure, the implantation of a programmable valve is advocated for patients needing a VP shunt but also suffering from pre-existing Menière’s disease.