Intended for healthcare professionals

Rapid response to:

Primary Care 10-minute consultation


BMJ 2005; 330 doi: (Published 27 January 2005) Cite this as: BMJ 2005;330:237

Rapid Response:

Dural puncture causing tinnitus

During a recent 10-minute consultation article the causes of tinnitus
were discussed 1. One cause not mentioned in the article was that of dural
puncture, most commonly associated with epidural or spinal anaesthesia.
Tinnitus as a result of dural puncture from an anaesthetic has been
recognised for many years in the anaesthetic literature 2 3, yet is often
not mentioned in other non-anaesthetic sources, including common ENT
textbooks 4-6, and the two references mentioned in the 10-minute
consultation 7 8. Though one would not expect an article approaching
tinnitus from a primary care setting to offer up an exhaustive list of
differential diagnoses, we believe dural puncture is worthy of mention
because, unlike many other causes of tinnitus, it is often very treatable
by use of an epidural blood patch.


1. Hannan SA, Sami F, Wareing MJ. Tinnitus. Bmj 2005;330(7485):237.

2. Vandam LD, Dripps RD. Long-term follow-up of patients who received
10,098 spinal anesthetics; syndrome of decreased intracranial pressure
(headache and ocular and auditory difficulties). J Am Med Assoc

3. Wong AY, Irwin MG. Postdural puncture tinnitus. Br J Anaesth

4. Scott-Brown WG, Evans JNG, Kerr AG. Scott-Brown's Otolaryngology.
London: Butterworths, 1987.

5. Gray RF, Hawthorne M. Synopsis of otolaryngology. 5. ed. Oxford:
Butterworth-Heinemann, 1992.

6. Becker W, Pfaltz CR, Naumann HH. Ear, nose, and throat diseases :
a pocket reference. 2., rev. ed. Stuttgart ; New York: Thieme, 1994.

7. Lockwood AH, Salvi RJ, Burkard RF. Tinnitus. N Engl J Med

8. Wareing MJ. Clinical review: rinnitus. GP Magazine 2004:41-2.

Competing interests:
None declared

Competing interests: No competing interests

28 February 2005
Martin J Beed
SpR Anaesthesia
Chris Hutter
Nottingham City Hospital, Nottingham, NG5 1PB