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

• Published in: European annals of otorhinolaryngology, head and neck diseases head and neck diseases, 2013-11, Vol.130 (5), p.283-287
• Main Authors: Achache, M, Sanjuan Puchol, M, Santini, L, Lafont, B, Cihanek, M, Lavieille, J.P, Devèze, A
• Format: Article
• Language: English
• Subjects: Adult; Air; Cochlear Aqueduct - injuries; Cochlear Aqueduct - surgery; Cochlear Diseases - complications; Cochlear Diseases - diagnosis; Cochlear Diseases - surgery; CT-scan; Delayed Diagnosis; Emergencies; Emergency trauma care; 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; Otolaryngology; Perilymph; Perilymphatic fistula; Pneumolabyrinth; Radiographic Image Enhancement; Radiographic Magnification; Skull Fractures - complications; Skull Fractures - diagnosis; Skull Fractures - surgery; Stapes - injuries; Temporal Bone - injuries; Temporal bone fracture; Tinnitus - etiology; Tomography, X-Ray Computed; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - diagnosis; Wounds, Nonpenetrating - surgery
• ISSN: 1879-7296; 1879-730X
• DOI: 10.1016/j.anorl.2012.04.012

Summary 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.