Late pneumolabyrinth after undiagnosed post-traumatic perilymphatic fistula. Case report illustrating the importance of systematic emergency management

Eur Ann Otorhinolaryngol Head Neck Dis. 2013 Nov;130(5):283-7. doi: 10.1016/j.anorl.2012.04.012. Epub 2013 Jun 10.

Abstract

Introduction: Temporal bone fracture is a common complication of high-energy cranial trauma. Labyrinth involvement is rare, but there is a risk of perilymphatic rupture that is often underestimated on initial clinical examination due to the predominance of neurological and/or somatic symptoms.

Case report: A patient presented with overlooked perilymphatic fistula, decompensated by hyperpressure effort due to poorly adapted management.

Discussion: Following a review of the literature on post-traumatic pneumolabyrinth, overall management (from diagnosis to treatment, via prevention advice) was analyzed. A constructive critique of the patient's treatment was thus made.

Conclusion: We argue for a systematic management protocol in cranial trauma with temporal bone fracture, comprising ENT examination, millimetric-scale cross-sectional imaging of the fracture site, and standardized counseling to prevent late complications.

Keywords: CT-scan; Emergency trauma care; Perilymphatic fistula; Pneumolabyrinth; Temporal bone fracture.

MeSH terms

  • Adult
  • Air*
  • Cochlear Aqueduct / injuries*
  • Cochlear Aqueduct / surgery
  • Cochlear Diseases / complications*
  • Cochlear Diseases / diagnosis*
  • Cochlear Diseases / surgery
  • Delayed Diagnosis
  • Emergencies*
  • Fistula / complications*
  • Fistula / diagnosis*
  • Fistula / surgery
  • Hearing Loss, Sudden / etiology
  • Humans
  • Labyrinth Diseases / etiology*
  • Labyrinth Diseases / surgery
  • Male
  • Mandibular Fractures / complications
  • Mandibular Fractures / diagnosis
  • Mandibular Fractures / surgery
  • Meniere Disease / etiology
  • Perilymph*
  • Radiographic Image Enhancement
  • Radiographic Magnification
  • Skull Fractures / complications*
  • Skull Fractures / diagnosis
  • Skull Fractures / surgery
  • Stapes / injuries
  • Temporal Bone / injuries*
  • Tinnitus / etiology
  • Tomography, X-Ray Computed
  • Wounds, Nonpenetrating / complications*
  • Wounds, Nonpenetrating / diagnosis
  • Wounds, Nonpenetrating / surgery