No abstract

From 1996 to 1998 in Marseilles, we lectured two courses on Endoscopic Ear Surgery. Today, in the world, many congresses are organized. One of the important benefits of an endoscope compared to the microscope is the wide field of view during ear surgery. Altogether there are numerous applications in the surgery of the middle ear. The routine, which uses optical systems for all Tympanoplasties, familiarises the surgeon with the endoscopic anatomy and provides a training for him.

P neumolabyrinth is a condition in which the vestibule and/or cochlea is filled with air. 1 Eustachian tube insufflation (ETI) is a type of treatment for recurrent serous otitis media that is still popular in Europe. It exploits the anti-inflammatory and mucolytic effects of thermal waters containing sulfur and bromo-iodine gas.To our knowledge, no case of a pneumolabyrinth due to barotrauma provoked by ETI has been described previously. The aim of this article is to present a patient who developed a pneumolabyrinth following ETI. Case ReportA 55-year-old woman was referred to our hospital complaining of vertigo and profound hearing loss in the left ear. One month before, she had undergone ETI because she had recurrent otitis media with effusion (OME). Immediately after the first insufflation, she developed vertigo, hearing loss, and tinnitus. Ten years earlier, she had a successful operation for left stapedotomy. Since then, she has denied symptoms or signs of perilymph fistula (PLF) as attacks of vertigo or hearing impairment.Otoscopy was normal bilaterally. Pure-tone audiometry revealed profound hearing loss in the left ear, and type A tympanograms were bilaterally observed. No spontaneous nystagmus was detected. Caloric test, vestibular-evoked myogenic potentials (ocular-VEMPs; cervical-VEMPs), and video head impulse test (vHIT) revealed a complete left areflexia. High-resolution computed tomography (HRCT) of the temporal bone revealed pneumolabyrinth (Figure 1). An exploratory tympanotomy showed fibrous tissue around the prosthesis with a small hole creating a communication between the middle ear and the scala vestibule. The oval window was sealed with fat and reinforced with perichondrium. Notwithstanding this, the symptoms did not improve and, 3 weeks postoperatively, HRCT showed the persistence of air in the inner ear. Another exploratory tympanotomy failed to heal the pneumolabyrinth. Thus, it was decided to perform a subtotal petrosectomy with blind sac closure of the external auditory canal (EAC) and obliteration of the eustachian tube. Finally, the middle ear and mastoid were obliterated with abdominal fat.Vestibular symptoms improved the day after this surgical procedure and had disappeared at 1 month. At this time, profound hearing loss persisted, and vHIT and VEMPs still revealed left areflexia. 2 The HRCT scan performed postoperatively at 2 ( Figure 2) and 6 months showed no signs of pneumolabyrinth. The institutional review board of Sapienza University approved the study.