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Updated: Aug 29, 2026
Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss
Published on: January 25, 2016
Unilateral hearing loss in children with shunt-treated hydrocephalus
Susan E Spirakis1, Raymond M Hurley
1Audiology Department, Children's Medical Service of Hillsborough County, Tampa, FL, USA.
Insights
Children with ventriculoperitoneal (VP) shunts may develop unilateral hearing loss. This cochlear hearing impairment, affecting the shunt side, could stem from altered cerebrospinal fluid (CSF) dynamics.
Area of Science:
- Pediatric Neurology
- Audiology
- Neurosurgery
Background:
- Hydrocephalus is a common neurological condition in children.
- Ventriculoperitoneal (VP) shunts are frequently used to manage hydrocephalus.
- Potential complications of VP shunts, including auditory effects, require investigation.
Purpose of the Study:
- To characterize hearing loss in children with ventriculoperitoneal (VP) shunted hydrocephalus.
- To determine the nature and location of auditory deficits.
- To explore potential mechanisms linking VP shunts to hearing impairment.
Main Methods:
- Recruited 12 children with patent VP shunts for hydrocephalus.
- Conducted comprehensive audiometric evaluations: pure-tone thresholds, tympanometry, acoustic reflex thresholds (ARTs), and distortion product otoacoustic emissions (DPOAEs).
- Analyzed hearing outcomes based on shunt laterality and hydrocephalus etiology (intraventricular hemorrhage or spina bifida).
Main Results:
- Identified unilateral, high-frequency cochlear hearing loss in the ear ipsilateral to VP shunt placement in 83% of participants.
- Observed no hearing loss in the contralateral ear.
- Audiometric findings and reduced DPOAE amplitudes indicated a cochlear origin for the hearing loss.
Conclusions:
- VP shunted hydrocephalus is associated with a specific pattern of unilateral cochlear hearing loss.
- Altered cochlear hydrodynamics due to reduced cerebrospinal fluid (CSF) pressure may cause this hearing loss.
- Evidence suggests potential brainstem involvement, possibly related to CSF drainage and cranial base changes.
Abstract:
This study investigated the characteristics of hearing loss in children with ventriculoperitoneal (VP) shunted hydrocephalus. Twelve hydrocephalic children with patent VP shunts participated. The etiology of the hydrocephalus was either intraventricular hemorrhage or spina bifida. Audiometric examination included pure-tone air conduction thresholds, tympanometry, contralateral and ipsilateral acoustic reflex thresholds (ARTs), and distortion product otoacoustic emissions (DPOAEs). A unilateral, high-frequency, cochlear hearing loss was found in the ear ipsilateral to the shunt placement in 10 (83%) of the 12 shunt-treated hydrocephalic children. No hearing loss was observed in the ear contralateral to shunt placement. Based on the pure-tone audiometric findings, coupled with the decrease in DPOAE amplitude in the shunt ear, the hearing loss appears to be cochlear in nature. We suggest that cochlear hydrodynamics are disrupted as the result of reduced perilymph pressure, a consequence of cerebrospinal fluid (CSF) reduction due to the combined effects of a patent shunt and a patent cochlear aqueduct. In addition, a concomitant brain stem involvement is evidenced in the ART pattern, possibly produced by the patent shunt draining the CSF from the subdural space, resulting in cranial base hypoplasia.
