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Immordino A, Lorusso F, Sireci F, Dispenza F. Acute pneumolabyrinth: a rare complication after cochlear implantation in a patient with obstructive sleep apnoea on CPAP therapy. BMJ Case Rep 2023; 16:e254069. [PMID: 37399343 PMCID: PMC10314444 DOI: 10.1136/bcr-2022-254069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
Pneumolabyrinth is a condition characterised by the presence of air within the inner ear and is a rare complication after cochlear implant surgery. One of the causes of pneumolabyrinth may be the increase in pressure in the middle ear. The use of continuous positive airway pressure (CPAP) is an effective treatment strategy for obstructive sleep apnoea. According to a recent study, the use of CPAP should be delayed by 1 or 2 weeks in subjects undergoing middle ear surgery; however, there is currently no indication to delay the CPAP in subjects undergoing cochlear implant surgery. We report the case of a patient on CPAP who underwent left cochlear implantation and, in the early postoperative period, reported severe vertigo and tinnitus. Cone-beam CT of the temporal bone revealed the presence of pneumolabyrynth. We believe that the use of CPAP should be delayed in subjects undergoing cochlear implantation to avoid the development of acute pneumolabyrinth.
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Affiliation(s)
- Angelo Immordino
- Biomedicine, Neuroscience and Advanced Diagnostics, Università degli Studi di Palermo, Palermo, Sicilia, Italy
| | - Francesco Lorusso
- U.O.C. Otorinolaringoiatria, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Sicilia, Italy
| | - Federico Sireci
- U.O.C. Otorinolaringoiatria, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Sicilia, Italy
| | - Francesco Dispenza
- Biomedicine, Neuroscience and Advanced Diagnostics, Università degli Studi di Palermo, Palermo, Sicilia, Italy
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2
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Improved Prediction of Hearing Loss after Temporal Bone Fracture by Applying a Detailed Classification for Otic Capsule-Violating Fracture: A Wide Scope Analysis with Large Case Series. Otol Neurotol 2023; 44:153-160. [PMID: 36624595 DOI: 10.1097/mao.0000000000003786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION This study aimed to analyze the predictability of temporal bone (TB) fracture-associated hearing loss by applying a detailed classification separating individual injury of the cochlea, vestibule, and semicircular canals (SCC). METHODS In this retrospective study, patients with otic capsule-violating (OCV) fractures were further classified as OCV-C(VS) when the cochlea was involved regardless of vestibule or SCC involvement, OCV-V(S) when the vestibule was involved regardless of SCC involvement, and OCV-S when the fracture only involved SCC. Hearing changes were compared by applying the above-mentioned classification, and TB fracture-induced facial palsy was also analyzed. RESULTS A total of 119 patients were included. Patients with OCV fractures had significantly worse bone conduction (BC) and air conduction (AC) thresholds (59.1 ± 25.3 and 87.0 ± 29.5 dB) than those with otic capsule-sparing (OCS) fractures (20.1 ± 17.9 and 36.5 ± 21.9 dB; p < 0.001 for each comparison). The BC and the AC thresholds of OCV-C(VS) (77.5 ± 11.0 and 114.2 ± 14.3 dB) and OCV-V(S) (69.3 ± 27.7 and 98.0 ± 22.2 dB) were significantly higher than OCV-S (40.1 ± 22.9 and 62.1 ± 25.6 dB; p < 0.001 for each comparison). The BC hearing thresholds were not significantly improved in the last pure tone audiometry when compared for total, OCV, or OCS cases. The AC threshold significantly improved in OCS cases. In a considerable number of cases with facial palsy, causative fracture lines involved the geniculate ganglion or tympanic segment without the involvement of the otic capsule. Most cases showed significant improvement; however, recovery was limited in cases with obvious fallopian canal disruption. CONCLUSIONS The cases with sole involvement of SCC had significantly better hearing thresholds than those with cochlear or vestibule involvement, even in OCV fracture cases.
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Koksal A, Ayyildiz V, Ogul H, Kantarci M. Case Report of a Patient With Posttraumatic Perilymphatic Fistula. EAR, NOSE & THROAT JOURNAL 2022:1455613221131302. [PMID: 36193877 DOI: 10.1177/01455613221131302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
On a perilymphatic fistula, there is an extravasation of the perilymph fluid into the middle ear cavity. Cross-sectional imaging techniques have very important role in evaluation of inner and middle ear structures and temporal bone. While thin section CT scans can show successfully pneumolabyrinth and temporal bone fracture, high-resolution 3D volumetric MRI sequences can help to demonstrate posttraumatic ear effusion and cerebrospinal fluid fistula into inner ear or middle ear.
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Affiliation(s)
- Ali Koksal
- Ankara Private Bayindir Hospital, Ankara, Turkey
- Department of Radiology, Vocational School of Health Services, Atilim University, Ankara, Turkey
| | - Veysel Ayyildiz
- Department of Radiology, Medical Faculty, Suleyman Demirel University, Isparta, Turkey
| | - Hayri Ogul
- Department of Radiology, Medical Faculty, Duzce University, Duzce, Turkey
| | - Mecit Kantarci
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
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DiPonio A, Sargent E, McClain K. Sudden Onset and Unremitting Vertigo in a Middle-aged Woman. JAMA Otolaryngol Head Neck Surg 2022; 148:576-577. [PMID: 35446367 DOI: 10.1001/jamaoto.2022.0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Anthony DiPonio
- Department of Otolaryngology-Head & Neck Surgery, Henry Ford Macomb Hospital, Clinton Township, Michigan
| | - Eric Sargent
- Department of Neurotology, Michigan Ear Institute, Farmington Hills.,Department of Neurotology, Lakeshore Ear, Nose, & Throat Center, St Clair Shores, Michigan
| | - Katie McClain
- Department of Otolaryngology-Head & Neck Surgery, Henry Ford Macomb Hospital, Clinton Township, Michigan.,Department of Pediatric Otolaryngology, Nemours Children's Health, Wilmington, Delaware
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Qureshi HA, Zeitler DM. Intratympanic Steroid Injection Complicated by Iatrogenic Perilymphatic Fistula: A Cautionary Tale. Laryngoscope 2021; 131:2088-2090. [PMID: 33973652 DOI: 10.1002/lary.29613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/31/2022]
Abstract
Intratympanic (IT) steroid therapy is a mainstay treatment for sudden sensorineural hearing loss (SSNHL) for both initial therapy and salvage therapy. We report a rare case of iatrogenic perilymphatic fistula that resulted from trauma during an IT steroid injection for SSNHL. We discuss the diagnosis and treatment in the current case and compare it with previous reports from the literature. Laryngoscope, 131:2088-2090, 2021.
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Affiliation(s)
- Hannan A Qureshi
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Daniel M Zeitler
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington, U.S.A
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Botti C, Castellucci A, Crocetta FM, Fornaciari M, Giordano D, Bassi C, Ghidini A. Pneumolabyrinth: a systematic review. Eur Arch Otorhinolaryngol 2021; 278:4619-4632. [PMID: 33881577 DOI: 10.1007/s00405-021-06827-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study is to provide a systematic review of the literature about the etiology, clinical and radiological presentation, surgical management, and outcomes of pneumolabyrinth (PNL). METHODS A systematic review of the literature was performed including studies published up to September 2020 in electronic databases (PubMed/MEDLINE, EMBASE, Cochrane Library, and Scopus). The PRISMA standard was applied to identify English, Italian, or French-language studies mentioning PNL. Full texts lacking information on the etiology were excluded. Data concerning the cause, site of air bubbles/fistula, clinical presentation, treatment, and outcome were collected. A qualitative synthesis of the results was performed. RESULTS Seventy-eight articles were eventually included; 132 patients were involved in the qualitative synthesis. The most common causes were: stapes surgery (24/132, 18.2%), temporal bone fracture (42/132, 31.8%), head trauma without temporal bone fracture (19/132, 14.4%), penetrating trauma (21/132, 15.9%), and barotrauma (15/132, 11.4%). The site most commonly involved was the vestibule (102/107, 95.3%), followed by cochlea (43/107, 40.2%) and semicircular canals (25/107, 23.4%). CONCLUSION The etiopathogenesis of PNL can be summarized in traumatic, iatrogenic, or inflammatory/infective. Its management consists in exploratory tympanotomy and sealing the fistula, but also conservative treatments can be attempted. Vestibular symptoms disappear in the majority of cases. Instead, the prognosis of hearing function is widely variable, and complete recovery is less probable. The certainty of evidence is still too low to make it useful for clinical decision-making.
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Affiliation(s)
- Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 41125, Modena, Italy.
| | - Andrea Castellucci
- Otolaryngology Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Maria Crocetta
- Otolaryngology Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Martina Fornaciari
- Otolaryngology Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Giordano
- Otolaryngology Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Enhanced Otolith Function Despite Severe Labyrinthine Damage in a Case of Pneumolabyrinth and Pneumocephalus Due to Otogenic Meningitis Associated With Superior Canal Dehiscence. Otol Neurotol 2021; 42:e101-e106. [PMID: 33026781 DOI: 10.1097/mao.0000000000002835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To describe a rare case of pneumolabyrinth (PNL) and pneumocephalus (PNC) due to otogenic meningitis in a patient with superior canal dehiscence (SCD) resulting in profound sensorineural hearing loss (SNHL), semicircular canals impairment but preservation of SCD-related enhanced otolith function. PATIENT A 65-year-old woman with otogenic meningitis. INTERVENTION Temporal bone high-resolution computed tomography (CT) scans, brain-magnetic resonance imaging, audiometry, bedside examination, video-head impulse test, and vestibular-evoked myogenic potentials (VEMPs). MAIN OUTCOME MEASURES Enhanced otolith function despite canal and cochlear loss. RESULTS The patient developed right profound SNHL and acute labyrinthitis. Imaging showed middle ear inflammatory tissue, right PNL and PNC despite lack of bony fractures. Bilateral SCD and tegmen dehiscence were detected. The patient underwent mastoidectomy, drainage of effusion, and surgical repair of tegmen dehiscence. Exploratory tympanotomy was uneventful. She was treated with intravenous antibiotics and dexamethasone for 3 weeks with improvement of general condition. At 3-weeks follow-up, right profound SNHL persisted with global hypofunction for ipsilateral semicircular canals and selective impairment for left superior canal activity at video-head impulse test. Surprisingly, both cervical and ocular-VEMPs exhibited bilaterally abnormal amplitudes and reduced thresholds, consistently with preserved SCD-related macular hypersensitivity to sounds even on the affected side. CONCLUSIONS This case report exhibits a unique clinical scenario as it offers interesting insights concerning PNL aetiology despite lack of either bony fractures or barotrauma and PNC likely conveyed intracranially by SCD. Moreover, it provides an unusual pattern of functional dissociation among inner-ear receptors showing enhanced otolith function despite severe labyrinthine damage.
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Hearing Recovery After Ejection of Air in a Case of Traumatic Pneumolabyrinth: Mechanism and Management Options. Otol Neurotol 2021; 41:359-363. [PMID: 31821260 DOI: 10.1097/mao.0000000000002538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe a case of traumatic pneumolabyrinth and subsequent hearing recovery after ejection of air with transcanal endoscopic surgical exploration. PATIENTS A 38-year-old man was struck by his child while cleaning his ear with an ear pick made of bamboo, which penetrated deep into the left ear canal. Severe vertigo with vomiting and left hearing impairment ensued. In addition, high-resolution computed tomography demonstrated an air density within the vestibule. INTERVENTIONS Exploratory tympanotomy was performed endoscopically a day after the injury and air was ejected from the oval window surgically. MAIN OUTCOME MEASURES High-resolution computed tomography, audiologic testing. RESULTS Several hours after surgery, the patient's subjective vestibular symptoms lessened and 7 days after surgery, the patient felt slight dizziness when moving his head and no apparent spontaneous nystagmus was observed with an infrared charge-coupled device camera and was discharged from the hospital. Two years later, there are no subjective vestibular symptoms at all and the pure-tone average of his left ear improved to 16.7 dB. CONCLUSION We presented a case of traumatic pneumolabyrinth and the subsequent hearing recovery after ejection of air following endoscopic exploratory tympanotomy. We propose that initial management for traumatic pneumolabyrinth should be ejection of the air bubble if it is located solely in the vestibule and sparing the cochlea.
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Uehara N, Fujita T, Nibu KI, Kakigi A. Traumatic perilymphatic fistula caused by a camellia branch: A case report. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2020. [DOI: 10.1080/23772484.2020.1840274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Natsumi Uehara
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan
| | - Takeshi Fujita
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan
| | - Ken-ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan
| | - Akinobu Kakigi
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan
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10
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Sarna B, Abouzari M, Merna C, Jamshidi S, Saber T, Djalilian HR. Perilymphatic Fistula: A Review of Classification, Etiology, Diagnosis, and Treatment. Front Neurol 2020; 11:1046. [PMID: 33041986 PMCID: PMC7522398 DOI: 10.3389/fneur.2020.01046] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/10/2020] [Indexed: 12/24/2022] Open
Abstract
A perilymphatic fistula (PLF) is an abnormal communication between the perilymph-filled inner ear and the middle ear cavity, mastoid, or intracranial cavity. A PLF most commonly forms when the integrity of the oval or round window is compromised, and it may be trauma-induced or may occur with no known cause (idiopathic). Controversy regarding the diagnosis of idiopathic PLF has persisted for decades, and the presenting symptoms may be vague. However, potential exists for this condition to be one of the few etiologies of dizziness, tinnitus, and hearing loss that can be treated surgically. The aim of this review is to provide an update on classification, diagnosis, and treatment of PLF. Particular attention will be paid to idiopathic PLF and conditions that may have a similar presentation, with subsequent information on how best to distinguish them. Novel diagnostic criteria for PLF and management strategy for PLF and PLF-like symptoms is presented.
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Affiliation(s)
- Brooke Sarna
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Catherine Merna
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Shahrnaz Jamshidi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Tina Saber
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States.,Department of Biomedical Engineering, University of California, Irvine, CA, United States
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11
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Dubrulle F, Chaton V, Risoud M, Farah H, Charley Q, Vincent C. The round window sign: a sensitive sign to detect perilymphatic fistulae on delayed postcontrast 3D-FLAIR sequence. Eur Radiol 2020; 30:6303-6310. [PMID: 32468106 DOI: 10.1007/s00330-020-06924-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/31/2020] [Accepted: 04/28/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study is to assess the diagnostic performance of a new MR sign, named the round window sign (RWS), to diagnose perilymphatic fistula (PLF) in a population of patients with chronic cochleo-vestibular symptoms, classified as definite or probable Menière's disease (MD). METHODS A total of 164 patients (mean age 52 ± 35 years) with chronic cochleo-vestibular symptoms underwent MRI, between 4 and 5 h after intravenous gadoteric acid injection (Dotarem®, 0.1 mmol/kg). MRI exploration was carried out on a 3-T Achieva® TX scanner. We analyzed the presence of the RWS, defined as a nodular FLAIR high signal in the round window (RW) and the presence of associated saccular hydrops. When this RWS was present, a temporal bone CT scan was performed and the RW was analyzed. RESULTS Of the 164 patients with definite MD (85 patients) or probable MD (79 patients), we found the RWS in 18 (11%), and 17/18 were classified into the group of probable MD. All these 18 patients showed other MR sequences considered as normal, including heavily weighted T2 imaging. Among these 18 patients, the temporal bone CT examination presented a filling of the RW in 13 patients (72%) and no filling of the RW in 5 patients (28%). Seven patients were surgically managed confirming in vivo the PLF diagnosis. The RWS was associated with the presence of a saccular hydrops in 4 cases. CONCLUSION Delayed postcontrast 3D-FLAIR may reveal perilymphatic fistulae in patients with probable Menière's disease using the round window sign. KEY POINTS • MRI with delayed acquisition can detect perilymphatic fistulae with perfect sensitivity, based on the presence of the round window sign. • This visual sign is only visible on a 3D-FLAIR sequence. • 3D-FLAIR sequence with delayed acquisition is more sensitive than temporal bone CT scan examination in detecting PLF.
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Affiliation(s)
- Frédérique Dubrulle
- Imaging Department, Head and Neck Unit, Huriez Hospital, CHU Lille, 59037, Lille, France.
| | - Victor Chaton
- Imaging Department, Head and Neck Unit, Huriez Hospital, CHU Lille, 59037, Lille, France
| | - Michael Risoud
- Otology and Oto-neurosurgery Department, Salengro Hospital, CHU Lille, 59037, Lille, France
| | - Hedi Farah
- Imaging Department, Head and Neck Unit, Huriez Hospital, CHU Lille, 59037, Lille, France
| | - Quentin Charley
- Otology and Oto-neurosurgery Department, Salengro Hospital, CHU Lille, 59037, Lille, France
| | - Christophe Vincent
- Otology and Oto-neurosurgery Department, Salengro Hospital, CHU Lille, 59037, Lille, France
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12
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Türk G, Kalkan M, Koç A. Post-traumatic pneumolabyrinth: a rare cause of hearing loss. Emerg Radiol 2020; 27:573-575. [PMID: 32445023 DOI: 10.1007/s10140-020-01789-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/04/2020] [Indexed: 11/27/2022]
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.
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Affiliation(s)
- Gamze Türk
- Department of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey.
| | - Mehmet Kalkan
- Department of Otolaryngology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ali Koç
- Department of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey
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13
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Varo Alonso M, Utrilla Contreras C, Díez Tascón Á, García Raya P, Martí de Gracia M. Traumatic injury of the petrous part of the temporal bone: Keys for reporting a complex diagnosis. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Kita AE, Kim I, Ishiyama G, Ishiyama A. Perilymphatic Fistula After Penetrating Ear Trauma. Clin Pract Cases Emerg Med 2019; 3:115-118. [PMID: 31061965 PMCID: PMC6497203 DOI: 10.5811/cpcem.2019.1.37404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 12/01/2018] [Accepted: 01/01/2019] [Indexed: 11/25/2022] Open
Abstract
Pneumolabyrinth, defined as air within the labyrinth on high-resolution computed tomography, suggests that a perilymphatic fistula (PLF) is present. PLF describes an abnormal communication between the middle and inner ear, and can result in deafness, vertigo, and imbalance. In the setting of a penetrating injury to the temporal bone or inner ear, pneumolabyrinth should trigger prompt otolaryngology consultation and urgent surgical exploration. We describe a case in which a 49-year-old male presented with a traumatic PLF secondary to penetrating ear injury. Imaging demonstrated extensive pneumolabyrinth. Despite delay in diagnosis, expeditious surgical intervention resulted in successful preservation of inner ear function.
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Affiliation(s)
- Ashley E Kita
- David Geffen School of Medicine at the University of California Los Angeles, Department of Head and Neck Surgery, Los Angeles, California
| | - Irene Kim
- David Geffen School of Medicine at the University of California Los Angeles, Department of Head and Neck Surgery, Los Angeles, California
| | - Gail Ishiyama
- David Geffen School of Medicine at the University of California Los Angeles, Department of Head and Neck Surgery, Los Angeles, California.,David Geffen School of Medicine at the University of California Los Angeles, Department of Neurology, Los Angeles, California
| | - Akira Ishiyama
- David Geffen School of Medicine at the University of California Los Angeles, Department of Head and Neck Surgery, Los Angeles, California
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15
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Traumatic Injury of the Petrous Part of the Temporal Bone: Keys for Reporting a Complex Diagnosis. RADIOLOGIA 2019; 61:204-214. [PMID: 30777299 DOI: 10.1016/j.rx.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/14/2018] [Accepted: 12/26/2018] [Indexed: 11/23/2022]
Abstract
Fractures of the petrous part of the temporal bone are a common lesion of the base of the skull; most of these fractures result from high-energy trauma. In patients with multiple trauma, these injuries can be detected on CT scans of the head and neck, where the direct and indirect signs are usually sufficient to establish the diagnosis. It is important to these fractures because the temporal bone has critical structures and the complexity of this region increases the risk of error unless special care is taken. This article reviews the key anatomical points, the systematization of the imaging findings, and the classifications used for temporal bone fracture. We emphasize the usefulness of identifying and describing the findings in relation to important structures in this region, of looking for unseen fractures suspected through indirect signs, and of identifying anatomical structures that can simulate fractures. We point out that the classical classifications of these fractures are less useful, although they continue to be used for treatment decisions.
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17
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Comacchio F, Guidetti G, Guidetti R, Mion M. Pneumolabyrinth and Recurrent Paroxysmal Positional Vertigo After Traumatic Stapes Fracture. Ann Otol Rhinol Laryngol 2018; 128:352-356. [PMID: 30556403 DOI: 10.1177/0003489418819553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES: The development of pneumolabyrinth without previous head trauma is a rare event; the associated symptoms may be nonspecific, and they can simulate various cochleo-vestibular pathological entities. The aim of the present study is to describe one of these rare occurrences, characterized by a peculiar onset. METHODS: We report a case of stapes fracture secondary to ear pick penetration into the middle ear with a pneumolabyrinth that caused a recurrent paroxysmal positional vertigo (PPV) mimicking a canalolithiasis. RESULTS: The patient developed a profound left sensorineural hearing loss and an intractable PPV with "migrant" features. A pneumolabyrinth was visualized with high-resolution computed tomography. A perilymphatic fistula (PLF) with stapes fracture was found while performing an explorative tympanotomy. After the surgical treatment of the PLF, the patient no longer complained of vestibular symptoms. CONCLUSIONS: To our knowledge, this is the fifth case of traumatic pneumolabyrinth simulating a canalolithiasis without previous history of temporal bone trauma and/or middle ear surgery. A pneumolabyrinth should be suspected in case of patients presenting recurrent intractable PPV after ear trauma.
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Affiliation(s)
- Francesco Comacchio
- 1 Regional Specialized Vertigo Center Veneto Region, Institute of Otolaryngology, Department of Neurosciences, Padova University, Padova, Italy
| | | | | | - Marta Mion
- 3 Institute of Otolaryngology, Department of Neurosciences, Padova University, Padova, Italy
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18
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Prenzler N, Schwab B, Kaplan D, El-Saied S. The role of explorative tympanotomy in patients with sudden sensorineural hearing loss with and without perilymphatic fistula. Am J Otolaryngol 2018; 39:46-49. [PMID: 29055686 DOI: 10.1016/j.amjoto.2017.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/24/2017] [Accepted: 10/08/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to describe the role of explorative tympanotomy in patients with Profound Sudden Sensorineural Hearing Loss (SSNHL) without clinical evidence of perilymphatic or labyrinthine fistula and to compare intraoperative findings with the postoperative hearing outcome. STUDY DESIGN Retrospective study of all patients diagnosed with SSNHL who underwent explorative tympanotomy between 2002 and 2005. SETTINGS Tertiary care university-affiliated hospital. SUBJECTS AND METHODS Eighty-two patients were diagnosed with unilateral profound SSNHL and underwent tympanotomy with sealing of the round and oval windows. Values of pure tone audiograms and percentage hearing loss of patients with and without intraoperative diagnosed perilymphatic fistula (PLF) were compared and analyzed. RESULTS PLF was diagnosed in 28% cases intraoperatively. In most cases, hearing improved significantly after surgery. Interestingly, patients with PLF had a 2.4 times greater decrease of percentage hearing loss compared to patients without PLF. CONCLUSIONS Explorative tympanotomy seems to be useful in patients with profound SSNHL. Patients with PLF benefit more from the surgical procedure and have better outcome than patients without PLF.
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Belmudes A, Couturier J, Gory G, Cauvin E, Condamin G, Rabillard M, Rault D. Computed tomographic characteristics of pneumolabyrinth in a French bulldog with otitis media and externa. Vet Radiol Ultrasound 2017; 60:E58-E61. [PMID: 29194857 DOI: 10.1111/vru.12578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/08/2017] [Accepted: 09/08/2017] [Indexed: 11/30/2022] Open
Abstract
A four-year-old female French bulldog was presented for evaluation of acute, left-sided peripheral vestibular syndrome. Computed tomographic (CT) examination of the head revealed the presence of air within the left cochlea and vestibule, consistent with pneumolabyrinth. This was concurrent with ipsilateral otitis media and externa. Pneumolabyrinth is an uncommon finding in humans and is most frequently due to head trauma and temporal bone fracture. This is the first report describing pneumolabyrinth in a dog, apparently of nontraumatic origin in this case.
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Affiliation(s)
- Audrey Belmudes
- AZURVET Referral Center in Veterinary Diagnostic Imaging, Neurology, Cardiology, Cagnes-sur-Mer, 06800, France
| | - Jérôme Couturier
- AZURVET Referral Center in Veterinary Diagnostic Imaging, Neurology, Cardiology, Cagnes-sur-Mer, 06800, France
| | | | - Eddy Cauvin
- AZURVET Referral Center in Veterinary Diagnostic Imaging, Neurology, Cardiology, Cagnes-sur-Mer, 06800, France
| | | | | | - Delphine Rault
- AZURVET Referral Center in Veterinary Diagnostic Imaging, Neurology, Cardiology, Cagnes-sur-Mer, 06800, France
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CT and MR Imaging of the Pediatric Temporal Bone: Normal Variants and Pitfalls. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0225-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Ballivet de Régloix S, Crambert A, Maurin O, Lisan Q, Marty S, Pons Y. Blast injury of the ear by massive explosion: a review of 41 cases. J ROY ARMY MED CORPS 2017; 163:333-338. [DOI: 10.1136/jramc-2016-000733] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/27/2016] [Accepted: 01/11/2017] [Indexed: 11/03/2022]
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Post traumatic deafness: a pictorial review of CT and MRI findings. Insights Imaging 2016; 7:341-50. [PMID: 27085885 PMCID: PMC4877355 DOI: 10.1007/s13244-016-0490-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/23/2016] [Accepted: 03/29/2016] [Indexed: 10/25/2022] Open
Abstract
UNLABELLED Hearing loss is a common functional disorder after trauma, and radiologists should be aware of the ossicular, labyrinthine or brain lesions that may be responsible. After a trauma, use of a systematic approach to explore the main functional components of auditory pathways is essential. Conductive hearing loss is caused by the disruption of the conductive chain, which may be due to ossicular luxation or fracture. This pictorial review firstly describes the normal 2-D and 3-D anatomy of the ossicular chain, including the incudo-malleolar and incudo-stapedial joints. The role of 3-D CT in the post-traumatic evaluation of injury to the temporal bone is then evaluated. In the case of sensorineural hearing loss, CT can detect pneumolabyrinth and signs of perilymphatic fistulae but fails to detect subtle lesions within the inner ear, such as labyrinthine haemorrhage or localized brain axonal damage along central auditory pathways. The role that MRI with 3-D-FLAIR acquisition plays in the detection of inner ear haemorrhage and post-traumatic lesions of the brain parenchyma that may lead to auditory agnosia is also discussed. KEY POINTS • The most common middle ear injuries are incudo-malleolar and incudo-stapedial joint luxation. • In patients with SNHL, CT can detect pneumolabyrinth or perilymphatic fistula • 3-D-FLAIR MRI appears the best sequence to highlight labyrinthine haemorrhage • Axonal damage and brain hematoma may lead to deafness.
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Abstract
BACKGROUND Pneumolabyrinth is a rare inner ear clinical manifestation. To date, only about 50 cases have been reported—all as case reports. Consequently, the rate and clinical characteristics of pneumolabyrinth have not been evaluated. METHODS Of the 38, 568 patients who visited our emergency department for head trauma, 466 underwent temporal bone computed tomography (CT). One hundred seventy-five patients had temporal bone fracture (13 bilateral temporal bone fractures; 188 ears with temporal bone fractures), and 14 patients had pneumolabyrinth (15 ears with pneumolabyrinth; 1 bilateral case). A retrospective review of their medical records and radiologic findings was performed. Temporal bone fractures were classified by two different systems: the traditional classification and an otic capsule-based classification. RESULTS Pneumolabyrinth occurred in 8.0% of all temporal bone fractures, 4.0% of longitudinal temporal bone fractures, 16.1% of transverse or mixed temporal bone fractures, and 48.4% of otic capsule-violating temporal bone fractures. In all cases, pneumolabyrinth was found on CT, which was performed within 3 days, but not on follow-up CT performed 5 days or longer after head trauma. All patients complained of hearing loss and dizziness. Hearing in most patients (83.3%) did not improve, whereas dizziness improved in 91.7% of patients. Air was located only in the vestibule or semicircular canal in 53.3% and in the vestibular or semicircular canal and cochlea in 46.6% of ears with pneumolabyrinth. The initial hearing threshold and recovery rate using pure-tone audiometry were not different according to the air location in the inner ear. CONCLUSION Pneumolabyrinth was more common than expected; we believe that the timing of evaluation affects its rarity. Pneumolabyrinth was detected in nearly 50% of patients with otic capsule-violating temporal bone fractures when CT scanning was performed early after trauma.
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Lee JS, Kwon SY, Kim JH, Kim HJ. Bilateral Sequential Pneumolabyrinth Resulting from Nose Blowing. J Audiol Otol 2015; 19:182-5. [PMID: 26771019 PMCID: PMC4704557 DOI: 10.7874/jao.2015.19.3.182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 11/22/2022] Open
Abstract
Pneumolabyrinth describes a condition with entrapped air in the labyrinth and usually occurs in temporal bone fractures that involve the otic capsule. While sporadic cases of bilateral pneumolabyrinth have been reported, cases lacking head trauma are very rare. We report the case of a 43-year-old man who had sudden hearing loss bilaterally after blowing his nose at an interval of 1 year. Although conservative management for the right ear and exploratory tympanotomy with sealing of the possible site of perilymphatic leakage in the left ear were performed, hearing outcome was poor in both ears. To our knowledge, this is the first case of bilateral pneumolabyrinth occurring as a result of nose blowing.
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Affiliation(s)
- Joong Seob Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sae Young Kwon
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji Heui Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyung-Jong Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
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Raoelina TR, Elziere M, Michel J, Devèze A. Intralabyrinthine penetrating ventilation tube with preservation of hearing: an unusual clinical situation. Int Arch Otorhinolaryngol 2014; 19:183-6. [PMID: 25992178 PMCID: PMC4399160 DOI: 10.1055/s-0034-1386505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 06/07/2014] [Indexed: 11/24/2022] Open
Abstract
Introduction Traumatic perilymphatic fistula is not a rare event with regards to sport activities or traffic accident. However, iatrogenic damage to the inner ear can occur following the common use of grommets and ventilation tube insertion. Objectives To report an unusual case of insertion of aeration tube into the vestibule trough the stapes footplate. Resumed Report A 62-year-old woman experienced iatrogenic penetration into the vestibule from a ventilation tube inserted for retraction pocket management. The event was misdiagnosed both by the surgeon and by the emergency room physicians, leading to delay in the management. However, preservation of the hearing function lasted for 2 weeks prior to deafness, thanks to the valve of Bast, which preserved the cochlear fluid. Conclusion This case gives us the opportunity to stress the need for systematic clinical examination of traumatic injury to the ear and to recommend performing multiplanar millimetric computed tomography scan with accurate interpretation. Traumatic injuries should be referred to a dedicated traumatic emergency referral center.
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Affiliation(s)
| | - Maya Elziere
- Department of Otolaryngology and Skull Base Surgery, University Hospital Nord, Marseille, France
| | - Justin Michel
- Department of Otolaryngology and Skull Base Surgery, La Timone University Hospital, Marseille, France
| | - Arnaud Devèze
- Department of Otolaryngology and Skull Base Surgery, University Hospital Nord, Marseille, France ; Laboratory of Applied Biomechanics IFSTTAR, Aix Marseille University, Bd Pierre Dramard, Marseille, France
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Treatment of traumatic stapediovestibular luxation: case report with the introduction of a new technique and review of literature. Otol Neurotol 2014; 35:582-8. [PMID: 24622014 DOI: 10.1097/mao.0000000000000322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Stapediovestibular luxations are rare lesions that are most commonly caused by direct, penetrating trauma to the external ear canal. In this type of ossicular dislocation, disruption of the annular ligament or footplate fracture may lead to a perilymphatic fistula (PLF) presenting with cochleovestibular symptoms including (progressive) sensorineural hearing loss, tinnitus, and vestibular symptoms. The objective of this article is to define the optimal treatment of stapediovestibular luxations and review the literature on this topic. PATIENT We present a case of internal stapediovestibular dislocation and pneumolabyrinth after penetrating trauma with predominantly conductive hearing loss and incapacitating vertigo. INTERVENTION Middle ear inspection with removal of the luxated incus, repositioning of the stapes with a "stapedial strut" and closure of the tympanic membrane. MAIN OUTCOME MEASURES Hearing outcome and vestibular symptoms of this patient are presented, and all comparable cases in the literature are reviewed. RESULTS Complete resolution of the vestibular symptoms and stabilization of the bone conduction thresholds. CONCLUSION In patients with pneumolabyrinth after middle ear trauma with mild symptoms, we recommend initial conservative treatment with close monitoring of hearing. In patients with severe, persisting, or progressive vestibulocochlear symptoms, exploratory tympanotomy should be performed to check for and treat PLF. Oval window fistula repair is reported to have variable hearing outcomes but offers complete resolution of vestibular symptoms in most cases. The stapedial strut is one of the possible surgical techniques in case of an internally luxated stapes.
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Bacciu A, Vincenti V, Prasad SC, Tonni D, Ventura E, Bacciu S, Pasanisi E. Pneumolabyrinth secondary to temporal bone fracture: a case report and review of the literature. Int Med Case Rep J 2014; 7:127-31. [PMID: 25246810 PMCID: PMC4166216 DOI: 10.2147/imcrj.s66421] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Pneumolabyrinth following temporal bone fracture is an extremely rare condition. It results from air entering the inner ear when a communication between the air-filled middle ear spaces and inner ear is established. The imaging modality of choice for pneumolabyrinth is high-resolution computed tomography of the temporal bone. Treatment options include conservative management (bed rest, antibiotics, corticosteroids) or surgery (exploratory tympanotomy). We present the case of a 31-year-old female who had pneumolabyrinth secondary to a temporal bone fracture. The patient was treated surgically and made a full clinical recovery.
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Affiliation(s)
- Andrea Bacciu
- Department of Clinical and Experimental Medicine, Unit of Audiology and Paediatric Otolaryngology, University Hospital of Parma, Parma, Italy
| | - Vincenzo Vincenti
- Department of Clinical and Experimental Medicine, Unit of Audiology and Paediatric Otolaryngology, University Hospital of Parma, Parma, Italy
| | - Sampath Chandra Prasad
- Department of Clinical and Experimental Medicine, Unit of Audiology and Paediatric Otolaryngology, University Hospital of Parma, Parma, Italy
| | - Daniela Tonni
- Department of Clinical and Experimental Medicine, Unit of Audiology and Paediatric Otolaryngology, University Hospital of Parma, Parma, Italy
| | - Elisa Ventura
- Department of Neuroradiology, University Hospital of Parma, Parma, Italy
| | - Salvatore Bacciu
- Department of Clinical and Experimental Medicine, Unit of Audiology and Paediatric Otolaryngology, University Hospital of Parma, Parma, Italy
| | - Enrico Pasanisi
- Department of Clinical and Experimental Medicine, Unit of Audiology and Paediatric Otolaryngology, University Hospital of Parma, Parma, Italy
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Wolter NE, Cushing SL, Das-Purkayastha PK, Papsin BC. Non-accidental caustic ear injury: two cases of profound cochleo-vestibular loss and facial nerve injury. Int J Pediatr Otorhinolaryngol 2012; 76:145-8. [PMID: 22018928 DOI: 10.1016/j.ijporl.2011.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 09/25/2011] [Accepted: 09/27/2011] [Indexed: 10/16/2022]
Abstract
Non-accidental caustic injury is a rare form of child abuse usually secondary to forced ingestion. Caustic injury to the ear most commonly arises from battery lodgement in the external canal. This case series represents the first report of non-accidental caustic injury to previously normal ears resulting in profound sensorineural hearing loss, vertigo with horizontal canal hypofunction and in one patient a severe facial nerve paralysis. Both patients required blind-end sac closure of the injured ear and one required sural nerve interposition combined with transfer of the masseteric branch of the trigeminal nerve to the ipsilateral facial nerve.
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Affiliation(s)
- Nikolaus E Wolter
- University of Toronto, Otolaryngology - Head and Neck Surgery, Canada.
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