This prospective observational study will evaluate postoperative hearing changes in women undergoing elective cesarean delivery under spinal anesthesia. Pure-tone audiometry will be performed before spinal anesthesia and at the predefined postoperative assessment time. The incidence, onset time, and severity of post-dural puncture headache (PDPH) will also be assessed. The study aims to determine whether hearing threshold changes occur after spinal anesthesia and whether these changes are associated with PDPH.

Spinal anesthesia is routinely used for elective cesarean delivery. Dural puncture may be associated with cerebrospinal fluid pressure changes that can affect inner-ear fluid dynamics and may result in transient changes in hearing thresholds. Post-dural puncture headache is another clinically relevant complication that may reflect cerebrospinal fluid loss and pressure changes.

Eligible women scheduled for elective cesarean delivery under spinal anesthesia will be enrolled consecutively after providing written informed consent. Spinal anesthesia will be administered according to routine clinical practice, with no additional anesthetic intervention performed for research purposes. Demographic and perioperative variables, including spinal needle gauge, sensory block level, hemodynamic measurements, vasopressor use, and occurrence of post-dural puncture headache, will be recorded. Pure-tone audiometry will be performed before surgery and at the predefined postoperative assessment time. Postoperative hearing thresholds will be compared with baseline values, and their association with post-dural puncture headache will be evaluated.

Inclusion Criteria:

• • Women aged 18 years or older.

  • Scheduled for elective cesarean delivery.
  • Planned spinal anesthesia.
  • ASA physical status I-II [revise if another ASA range is approved in the protocol].
  • Ability to complete preoperative and postoperative pure-tone audiometry assessments.
  • Provision of written informed consent.

Exclusion Criteria:

• • Pre-existing hearing loss, use of hearing aids, or inability to complete audiometric testing.

  • History of chronic otologic disease, ear surgery, or active ear infection.
  • Contraindication to spinal anesthesia.
  • Conversion to general anesthesia before completion of the protocol assessments.
  • Refusal to participate or withdrawal of consent.
  • [Add any protocol-specific exclusions approved by the ethics committee, such as chronic headache disorder, hypertensive disease of pregnancy, or major perioperative hemorrhage, only if applicable.](streamdown:incomplete-link)

The study population will consist of pregnant women scheduled for elective cesarean delivery under spinal anesthesia at Duzce Unıversıty Medical Faculty Hospital Eligible participants will be enrolled consecutively after providing written informed consent. All participants will undergo routine spinal anesthesia as part of standard clinical care. Pure-tone audiometry will be performed preoperatively and within 48 hours postoperatively. Participants will also be followed for 7 days after spinal anesthesia for the occurrence of post-dural puncture headache.