Restoration of Balance and Unilateral Hearing Using Alternating and Filtering Auditory Training in Shunt-Treated Hydrocephalus Following Subarachnoid Hemorrhage: A Case Report

Patient: Female, 54 Final Diagnosis: Ruptured aneurysm in the anterior communicating artery and hydrocephalus Symptoms: Hemi-hyposthenia • proprioceptive left-sided ataxia • temporospatial disorientation • memory disorder • hearing loss Medication: Nicardipine Clinical Procedure: Shunting and neurorehabilitation program Specialty: Neurology OBJECTIVE: Unusual or unexpected effect of treatment BACKGROUND: Although rehabilitation for balance disorders is commonly undertaken following a stroke, hearing dysfunction is rarely investigated, even though hearing loss affects the ability to maintain balance. This report presents a case of restoration of balance and unilateral hearing using an alternating and filtering auditory training (AFAT) protocol in a patient with subarachnoid hemorrhage (SAH) and shunt-treated hydrocephalus. CASE REPORT: A 54-year-old woman with a five-month history of SAH due to a ruptured aneurysm in the anterior communicating artery and hydrocephalus treated with a shunt was admitted to our unit for neurorehabilitation. The patient had a history of anorexia. Her initial neurological examination on admission for rehabilitation therapy showed postural instability, hemi-hyposthenia, proprioceptive left-sided ataxia, a confusional state including temporospatial disorientation, memory disorder and hearing loss. Two weeks after the start of her neurorehabilitation program the AFAT program was commenced. Pure tone audiometry (PTA) showed lower left hearing thresholds, extending from a hearing level (HL) of between 5–25 decibel (dB) or more when compared with the right ear. With a rapid and improved regain of unilateral hearing loss, balance, cognitive, and motor function also improved. CONCLUSIONS: This case report supports that patients who undergo rehabilitation following stroke, SAH, and hydrocephalus might benefit from a rehabilitation program that includes hearing assessment and early improvement of hearing loss, leading to a shorter rehabilitation time.