Stapediovestibular dislocation with pneumolabyrinth

Abstract

Traumatic luxation of the stapes into the vestibule is a rare entity, and the disease complicated with pneumolabyrinth is extremely rare. We report the case of a 72-year-old woman with pneumolabyrinth associated with a stapediovestibular dislocation. The patient presented with vertigo and nystagmus following penetrating trauma to the middle ear. High resolution computed tomography scans demonstrated air in the vestibule and dislocation of the stapes. Exploratory tympanotomy demonstrated oozing of the perilymph from the oval window and depression of the stapes into the vestibule. Pneumolabyrinth and stapes luxation detected by high resolution computed tomography should be predictive of a perilymphatic fistula.

Traumatic stapes fracture with rotation and subluxation into the vestibule and pneumolabyrinth

“…It implies a pathological connection between the inner and middle ear and/or petromastoid aircells 5. Other causes include spontaneous fistula and stapes prosthesis displacement 1. Rare association with stapediovestibular disruption has infrequently been described.…”

“…Blunt or penetrating trauma rarely causes stapes subluxation into the vestibule, due to the inherent strength of the annular ligament. When it does occur, a simple depression of the footplate medially into the vestibule usually occurs 1, 3, 4. We present a rare case of stapes fracture with stapes rotation and subluxation into the vestibule, and associated pneumolabyrinth.…”

“…It is usually associated with a traumatic temporal bone or stapes footplate fracture. Pneumolabyrinth is often part and parcel of a perilymphatic fistula,1 with sensorineural hearing loss and dizziness. In the instance of a stapes fracture, a more common occurrence in children,2 the mechanism of injury depends on the direction of the external force and the orientation of the fracture line.…”

Stapediovestibular dislocation depicted on temporal bone computed tomography with 3D rendering

“…A comminuted fracture of the oval window can also lead to stapediovestibular dislocation. Stapediovestibular disruption can result in a perilymphatic fistula, which is often indicated by the presence of pneumolabyrinth [2,3].High-resolution CT of the temporal bone is the imaging modality of choice for evaluating ossicular injuries. Displacement of the stapes can be demonstrated on standard axial, coronal, or oblique CT images.…”

“…A comminuted fracture of the oval window can also lead to stapediovestibular dislocation. Stapediovestibular disruption can result in a perilymphatic fistula, which is often indicated by the presence of pneumolabyrinth [2,3].…”