Pneumolabyrinth Case Study

Introduction

Pneumolabyrinth is the presence of air in the vestibular and/ or the cochlear organs due to a pathological communication between the middle and inner air.1-2 Pneumolabyrinth caused by a temporal bone fracture was first described in 1988 by Nurre et al.3 Traumatic pneumolabyrinth secondary to temporal bone fracture is a rare entity with only 15 cases reported thus far.1 Neurotological symptoms following a head trauma usually necessitate a computed tomography imaging (CT).4 Pneumolabyrinth is managed either conservatively or by surgical internvention. Symptoms include sensioneural hearing loss (SNHL), tinnitus, aural fullness, and dizziness.1 Pneumolabyrinth can result from a temporal bone fracture, luxation of the stapes into the

His symptoms began three weeks ago ensuing a skating accident. One week post trauma, the patient visited the emergency room. At the time of the trauma, loss of consciousness, unsteadiness and transient amnesia were reported. His Glasgow coma scale was 15 and his pupils were equal and reactive to light. Furthermore, the patient reported a decreased hearing on his right ear. The initial brain CT imaging did not reveal a temporal bone fracture. However, left frontal, right and left inferior temporal bone contusions were reported. In addition, there was left parieto-temporal extra-axial hemorrhage with a 3mm maximum thickness. Right sided wall erythema on ear examination was viewed as a possible otitis media by the ER physician. Three weeks post trauma, the patient returned to the emergency room complaining of a right ear hearing loss and tinnitus. He was then referred to the otolaryngology department. Upon examination, the facial nerve was intact. The tympanic membrane was normal bilaterally. Weber test was lateralized to the left and Rinne test was positive in the left. Tympanometry showed a normal right ear tympanogram. Left ear tympanometry showed a hypercompliant ear. Stapedial reflex was absent in the right air. Pure tone audiogram demonstrated a right-sided profound sensioneural hearing loss. Upon the revision of the CT imaging, otic capsule violating fracture was detected. Foci

Air confined only to the cochlea was seldom reported.2,5 The mean age at presentation was 25 years with male preponderance.1 CT imaging is a valuable tool to diagnose traumatic pneumolabyrinth. Since the absence of a temporal bone fracture on the initial CT doses not necessarily eliminate a vestibular, cochlear or ossicular chain involvement, a millimeter-scale slices directed towards the temporal bone is recommended.9 In our patient, pneumolabyrinth might have been detected earlier with the use of a high-resolution CT scan centered towards the temporal bone with a bone window in the axial and coronal planes. Vestibular symptoms usually have more favorable prognosis after treatment. Whereas, hearing recovery outcome after traumatic pneumolabyrinth is assumed to be influenced by the following factors: the interval until surgery, the presence of stapes lesions and air location on CT. With longer interval until surgery, hearing recovery was reduced. 54% of Patients receiving surgery with an injury to surgery interval less than 2 weeks demonstrated an improved