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.

Keywords: ear, nose and throat/otolaryngology; otolaryngology/ent.

Figure 1

Audiogram at admission revealing profound left sensorineural hearing loss (pure-tone average 110 dB) along with the presence of a right scotoma at a frequency of 4000 Hz at 40 dB (pure-tone average 23.75 dB).

Figure 2

Temporal bone high-resolution CT scan (axial view) revealing air bubbles (arrows) trapped in the vestibule and cochlea of the left ear, without signs of temporal bone fracture, disruption of the ossicles or soft tissue density in the temporal bone.

Figure 3

Temporal bone high-resolution CT scan (coronal view) revealing air bubbles trapped (arrow) in the cochlea of the left ear, without signs of temporal bone fracture, disruption of the ossicles or soft tissue density in the temporal bone.

Figure 4

Temporal bone high-resolution CT scan (coronal view) revealing air bubbles trapped (arrows) in the vestibule of the left ear, without signs of temporal bone fracture, disruption of the ossicles or soft tissue density in the temporal bone.

Figure 5

Intraoperative verification of perilymphatic fistula at the location of the round window.

Figure 6

Intraoperative visualisation of the correction of the defect in the round window with fat from lobule of pinna and fibrin glue.

Figure 7

Intraoperative visualisation of the correction of the defect in the round window with fat from lobule of pinna and fibrin glue.