Perilymphatic fistula and pneumolabyrinth without temporal bone fracture: a rare entity

Abstract

Post-traumatic pneumolabyrinth is an uncommon clinical entity, particularly in the absence of temporal bone fracture. We report the case of a patient who presented to our emergency department with a headache, sudden left hearing loss and severe dizziness which began after a traumatic brain injury 3 days earlier. On examination, the patient presented signs of left vestibulopathy, left sensorineural hearing loss and positive fistula test, normal otoscopy and without focal neurological signs. The audiometry confirmed profound left sensorineural hearing loss. Cranial CT revealed a right occipital bone fracture and left frontal subdural haematoma, without signs of temporal bone fracture. Temporal bone high-resolution CT scan revealed left pneumolabyrinth affecting the vestibule and cochlea. Exploratory tympanotomy revealed perilymphatic fistula at the location of the round window. The sealing of defect was performed using lobule fat and fibrin glue. He presented complete resolution of the vestibular complaints, though the hearing thresholds remained stable.

Transcanal Endoscopic Ear Surgery for The Management of Pediatric Perilymphatic Fistula Caused by Trauma

“…Most vestibular symptoms improve postoperatively, but hearing improves to varying degrees in such cases of PLF with pneumolabyrinth due to the permanent damage that depends on the type and severity of cochlear trauma. [1][2][3][4] Furthermore, if the pneumolabyrinth involves the cochlea, as in this case, the possibility of no improvement or even worsening of hearing despite conservative treatment is higher than if the pneumolabyrinth involves only the vestibule. 1) However, improvement in hearing and vestibular symptoms was obtained through surgical treatment in this case.…”

“…In most cases of traumatic PLF caused by head trauma, pneumolabyrinth is accompanied by temporal bone fracture, and hence, pneumolabyrinth without temporal bone fracture is rare. 1,2) As such, the diagnosis guidelines and treatment protocols are not clearly established for this condition due to the limited number of reported cases. 3,4) Transcanal endoscopic ear surgery (TEES) was first introduced in 1993 by Thomassin, et al 5) Currently, TEES is accepted as an effective surgical method to examine the middle ear cavity for the diagnosis and treatment of several otologic diseases, including PLF.…”

Prospective Evaluation of the Efficacy of Isolated Balloon Eustachian Tuboplasty: Short- and Medium-term Follow-up Results Based on Tubomanometry, ETDQ-7, Tympanometry, and Valsalva Maneuver

“…In bilateral cases, patients completed separate pre- and postprocedure side-specific ETDQ-7 for each ear. We used the validated ETDQ-7 to European Portuguese 8 and determined the total scale score cutoff value of 14.5 to define patients with or without ETD (ETDQ-7 maximum score: 49 points)…”

Neumolaberinto como complicación de otitis media crónica colesteatomatosa

“…Se indica tratamiento quirúrgico en casos de sintomatología vestibular severa, progresión de la hipoacusia o sospecha de FPL activa. 8 El pronóstico para los síntomas vestibulares suele ser bueno. En cuanto a la audición, el pronóstico es menos predecible.…”

“…Se recomienda iniciar con manejo conservador y reservar el tratamiento quirúrgico para casos con sintomatología vestibular severa, progresión de la hipoacusia o FPL activa. 5,8 Este caso se manejó en inicio de manera conservadora con reposo, evitando la maniobra de Valsalva, elevación de la cabecera, esteroide sistémico, antibiótico y antivertiginosos con lo cual se obtuvo una mejoría parcial de la sintomatología vestibular, pero no una mejoría auditiva. 5,7 Ante la presencia de una FPL, existe riesgo de laberintitis supurativa y meningitis, el cual es aún más elevado en casos como el nuestro, debido a la presencia de tejido de colesteatoma adyacente al sitio de fístula, por ello fue que se decidió el manejo quirúrgico.…”