BILATERAL SENSORINEURAL HEARING LOSS FOLLOWING NON OTOLOGIC SURGERY

INTRODUCTION: A 58 years old man with a no history of hearing loss was admitted with comminuted fracture tibia and fibula (right), sustained in a road traffic accident [Fig. 1]. He had no known comorbidity. The pre-operative history and physical examination, blood test investigations, chest radiograph [Fig. 2] and ECG were unremarkable. He was taken up for open reduction and pinning of fractured segments [Fig. 3]. The orthopedic surgery itself was uneventful with the patient being under general anesthesia for a total of one hour. Induction of anesthesia was uncomplicated, and blood loss was minimal. The blood pressure and pulse remained stable, with minimum diastolic and systolic pressure during surgery being 70 mmHg and 130 mmHg respectively. Oxygen saturation remained over 95 percent. In the post-operative ward, he received parenteral antibiotic cover with Inj Augmentin. Additionally he was given Inj Diclofenac for analgesia and Inj Ondensatron for nausea. Shortly after transfer to the ward, he complained of tinnitus and being unable to hear in either ear. There was no nausea, vomiting, or vertigo. An otolaryngology consultation at this time showed normal cranial nerve, cerebellar, oculomotor and fundoscopic exams. Audiometry showed bilateral profound 100 dB and 105 dB sensorineural hearing loss in the right and left ears respectively [Fig. 4]. Blood tests including sedimentation rate, coagulation profile, blood count, smear examination, lipid profile, serum thyroid hormone levels, renal and liver function tests were all normal. CT scan of skull was normal except for mild diffuse cerebral atrophy [Fig. 5, 6, 7]. He was placed on conservative management with oral steroids (50 mg/day) for 10 days. Serial audiograms of the patient thereafter showed mild improvement, with residual hearing loss in both ears of 80dB. After four weeks, there continues to be hearing loss in both ears [Fig. 8]. Speech comprehension continues to be difficult for the patient, with speech discrimination scores being less than 50 percent in both ears.