Pneumolabyrinth: A Late Complication of Stapes Surgery

Abstract

As temporal bone imaging techniques continue to improve, it is likely that we will see an increase in the detection ofpneumolabyrinth. Several mechanisms have been proposed to explain how air enters the labyrinth. A small number of authors has reported an association between pneumolabyrinth and temporal bone fractures, perilymphatic fistulae, and displaced stapes prostheses. In this article, we describe a new case ofpneumolabyrinth that was seen as a late complication ofstapes surgery, and. we summarize what is known about this rare condition.

Computed Tomographic Imaging of Stapes Implants

“…No measurements were made, and the patient did not undergo exploration. Another author described CT imaging of 1 patient 2 decades after stapes surgery that developed hearing loss and disequilibrium (6). The images were obtained in 1-mm sections, and the stapes prosthesis was visualized in the vestibule and is described to be in a Bmedial[ position deep in the vestibule; however, again, no exact measurement was made, and the patient did not undergo surgical revision.…”

Traumatic Pneumolabyrinth

“…In 19 cases, stapes lesions including fracture, subluxation into the vestibule, and PLF from the oval window were confirmed intraoperatively. Moreover, 1 case after stapedectomy (17), with hearing recovery after conservative therapy, was included as positive for stapes lesion since CT clearly revealed subluxation of the stapes prosthesis into the vestibule. Among the resulting 20 cases, 6 (30%) showed improvement in air conduction hearing threshold (Table 2D).…”

Late pneumolabyrinth after stapedectomy

“…Only two case reports are published in the literature on pneumolabyrinth as a delayed complication of stapes surgery [4,5]. The first case was described in 2001 by Scheid et al; a 56-year-old woman who presented 16 years after a left stapedectomy with disequilibrium, aural fullness and intermittent tinnitus.…”

“…She was diagnosed with pneumolabyrinth and stapes prosthesis migration on HRCT. The authors recommended an exploratory tympanotomy for patients who are diagnosed with pneumolabyrinth and who are having a persistent vertigo and/or fluctuating or progressive sensorineural hearing loss [4].…”

“…Pneumolabyrinth has been previously reported as a complication of temporal bone trauma or stapes surgery in the English literature [2,3] however it has only been reported twice as a late complication of stapes surgery [4,5].…”