Pneumolabyrinth secondary to temporal bone fracture: a case report and review of the literature

Abstract

Pneumolabyrinth following temporal bone fracture is an extremely rare condition. It results from air entering the inner ear when a communication between the air-filled middle ear spaces and inner ear is established. The imaging modality of choice for pneumolabyrinth is high-resolution computed tomography of the temporal bone. Treatment options include conservative management (bed rest, antibiotics, corticosteroids) or surgery (exploratory tympanotomy). We present the case of a 31-year-old female who had pneumolabyrinth secondary to a temporal bone fracture. The patient was treated surgically and made a full clinical recovery.

Computed tomographic characteristics of pneumolabyrinth in a French bulldog with otitis media and externa

“…The most commonly reported clinical signs associated with pneumolabyrinth include hearing loss and sudden vestibular syndrome with dizziness and vomiting . An acute vestibular syndrome with vomiting was typically observed in this case.…”

“…Pneumolabyrinth has been described as a rare clinical manifestation in humans, defined as the presence of air within the cochlea, vestibule, semicircular canals or both. It is classified as cochlear, vestibular, or combined pneumolabyrinth . In humans, pneumolabyrinth can be caused by an abnormal communication between the inner ear and surrounding structures, usually the tympanic cavity .…”

“…Potential gas entry sites include vestibular or cochlear windows, the fissula ante fenestram, and microfissures between the posterior semicircular canal and the cochlear window . In most cases, pneumolabyrinth is of traumatic origin, secondary to a head trauma with temporal bone fracture . Nontraumatic pneumolabyrinth is much less common .…”

“…More studies are needed on similar cases in dogs to investigate if pneumolabyrinth evaluation may be improved by specific protocols. MRI is not appropriate to detect pneumolabyrinth, since it cannot distinguish cortical bone from air . However it remains useful to detect other comorbidities such as otitis interna or meningitis.…”

“…Mean attenuation values measured inside the cochlea and vestibule were respectively –1036 Hounsfield Units (HU) and –1042 HU. Based on these CT findings, the diagnosis was left‐sided pneumolabyrinth and concurrent ipsilateral otitis media and externa.…”