Blood patch for the treatment of post-dural puncture tinnitus

摘要

Audiometric disturbances are recognised as potential complications after spinal or epidural anaesthesia; however, incidences of tinnitus occur less frequently. We report a case of a patient with severe bilateral tinnitus post-lumbar puncture who was treated with an epidural blood patch. A 40-year-old ASA I lady (a medically fit patient with no known medical problem) presented with ongoing bilateral severe tinnitus for 6 days after a lumbar puncture. Venous blood (18 mL) was injected into the epidural space using a 16G needle. The patient completed the Tinnitus Handicap Inventory Questionnaire before the blood patch, 3 h, 24 h and 1-month post-procedure. An audiogram was also conducted before and 1 month after the blood patch. The patient scored 84 (grade 5) on the Tinnitus Handicap Inventory before the blood patch. Three hours post-procedure, her score improved to 16 (grade 1), with complete resolution by 24 h. Audiogram revealed a low-frequency mild sensorineural hearing loss in the left ear prior to the procedure. By her 1-month follow-up, her hearing loss was back to normal. In our experience, an epidural blood patch is an effective treatment for post-dural puncture tinnitus. Its effects are instantaneous and complete resolution is achieved by 24 h.