Pneumolabyrinth following Eustachian Tube Insufflation

Abstract

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.

Association of Obstructive Sleep Apnea-Hypopnea Syndrome with hearing loss: A systematic review and meta-analysis

“…Impaired Eustachian tube function is often referred to as Eustachian tube dysfunction. Clinical manifestations of ETD are aural fullness, otalgia and/or hearing loss or could be a “latent” condition ( 54 – 56 ). Magliulo et al ( 57 ) assessed that In patients with obstructive sleep apnea syndrome, several factors (nasal obstruction, increase in upstream airflow resistance, inflammation of the rhinopharynx and the Eustachian tube (ET) orifice mucous) could be responsible for ET collapse, hindering its correct opening to exchange air with the middle ear.…”

Pneumolabyrinth following Eustachian Tube Insufflation

“…Magliulo et al recently reported an interesting case of “pneumolabyrinth following Eustachian tube insufflation” in Otolaryngology–Head and Neck Surgery. 1 Pneumolabyrinth, as it has been described in the article, is a condition of vestibule and/or cochlea dysfunction due to the presence of air within the labyrinth. It is caused by a perilymphatic fistula that can be the result of temporal bone trauma, barometric pressure changes, or otologic surgery.…”