Post-traumatic pneumolabyrinth: a rare cause of hearing loss
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CASE REPORT
Post-traumatic pneumolabyrinth: a rare cause of hearing loss Gamze Türk 1
&
Mehmet Kalkan 2
&
Ali Koç 1
Received: 16 February 2020 / Accepted: 4 May 2020 # American Society of Emergency Radiology 2020
Abstract Pneumolabyrinth (PL) is the presence of air within the vestibule, semicircular canals, or cochlea. It represents an abnormal connection between the inner ear and middle ear spaces. PL most commonly occurs after blunt head trauma, followed by penetrating injuries. Temporal fractures may or may not accompany. Prognosis of hearing loss is poor, while prognosis of vestibular symptoms is good. Herein we present a 45-year-old female with unilateral pneumolabyrinth, who presented with significant dizziness and unilateral total hearing loss after a car accident. Keywords Pneumolabyrinth . Vertigo . Irauma . Computed tomography . Hearing loss
Introduction Pneumolabyrinth (PL) describes the presence of air within the inner ear structures, and is the hallmark of an abnormal connection between the inner ear and middle ear spaces. Several causes have been reported in the literature. Patients may present with aural fullness, vestibular symptoms, and/or hearing loss. Although vestibular symptoms recover as the PL resolves, hearing loss is usually permanent. Herein we present a case of posttraumatic PL secondary to temporal bone fracture without hearing loss improvement.
Case report A 45-year- old female was admitted to emergency room after a car accident. On arrival, her Glasgow Coma Scale (GCS) was 15. She was conscious and well oriented. Her vitals were stabilized. She had no clinical history besides polycystic kidney disease and hepatic cysts. She described left aural fullness and significant
* Gamze Türk [email protected] 1
Department of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey
2
Department of Otolaryngology, Kayseri Training and Research Hospital, Kayseri, Turkey
dizziness that she was unable to sit during examination. She had total hearing loss on the left as well. Physical examination showed hemotympanium on the left side. There was no facial palsy. Based on her symptoms, a non-enhanced computed tomography (CT) was obtained (Fig. 1). CT scan showed subarachnoid hemorrhage in the right Sylvian fissure. There were multiple fractures of the left maxillary sinus with dens opacification. Left external auditory meatus, tympanic cavity, and mastoid air cells were also opacified. Temporal fracture extending from the squamous portion to the base of the cranium passing anterior to mandibular fossa was evident. Another longitudinal fracture was seen extending from mastoid cells to ceiling of external auditory meatus, sparing the otic capsule. The ossicles were intact. Air was seen in the vestibule, posterior and superior semicircular canals (SCC), and basal turn of cochlea. Additionally, on thin slice images, a thin hypodense line extending from vestibule to jugular notch was detected, suggesting a fracture. There was no stapes subluxation or discontinuation of bony covering
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