额骨骨瘤切除术后突发双侧听力损失与上半规管裂相关

文献信息

中文摘要

非耳科手术后突发感音神经性听力损失（SNHL）是一种罕见但可能具有破坏性的并发症。我们报告一例在全麻下择期额骨骨瘤切除术后发生的双侧SNHL。一名52岁女性，既往无听力障碍，在麻醉苏醒后立即出现重度双侧听力损失，数小时内部分自发改善，随后以右侧为主并伴耳鸣。影像学排除了缺血性病变。听力学检查显示一过性双侧噪声诱导型模式，右耳持续存在轻度高频SNHL。进一步检查发现双侧上半规管裂（SSCD）。我们提出，术中凿骨产生的振动能量通过预先存在的“第三窗”异常传递至内耳，从而促发听力损失。本病例突出了非耳科手术后SNHL的一种新的潜在机制，并对涉及颅骨振动的围手术期风险咨询提出了重要考虑，尤其鉴于SSCD的无症状患病率。

英文摘要

Sudden sensorineural hearing loss (SNHL) following non-otologic surgery is a rare but potentially devastating complication. We report a case of bilateral SNHL occurring after elective excision of a frontal bone osteoma under general anaesthesia. A 52-year-old woman with no prior hearing impairment developed profound bilateral hearing loss immediately on emergence from anaesthesia, with partial spontaneous improvement over hours and subsequent right-sided predominance with tinnitus. Imaging excluded ischaemic pathology. Audiometry demonstrated a transient bilateral noise-induced pattern, with persistent mild high-frequency SNHL on the right. Further investigation revealed bilateral superior semicircular canal dehiscence (SSCD). We propose that vibrational energy from intraoperative chiselling was abnormally transmitted to the inner ear via a pre-existing "third window" precipitating hearing loss. This case highlights a novel potential mechanism for postoperative SNHL in non-otologic surgery and raises important considerations regarding perioperative risk counselling for procedures involving skull vibration, particularly given the asymptomatic prevalence of SSCD.