Artikel
Extreme sensitivity of hearing to decreases of intracranial pressure in Menière’s disease
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Veröffentlicht: | 20. Mai 2009 |
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Gliederung
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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.