Traumatic perilymphatic fistula with the luxation of the stapes into the vestibule
Introduction
Direct traumatic damage to the external ear canal and tympanic membrane is a common finding in the otolaryngologic practice. Prognosis in cases with damage to the ossicular chain is fairly good. In contrast, damage to the inner ear is less frequent, but severe hearing loss may occur, even with adequate treatment [1], [2], [3], [4].
Diagnosis of perilymphatic fistula after penetrating trauma to the middle ear is not usually difficult. In many cases, vertigo, nystagmus, mixed or pure sensorineural hearing loss, and tinnitus related to the cochleovestibular damage often occur immediately after injury. It is difficult, however, to evaluate the extent of the damage and the precise condition of the middle and inner ear before surgery. When a luxation of the stapes into the vestibule is suspected, it is important to determine how deeply depressed the stapes might be and whether it is fractured [2], [3], [4], [5], [6]. When such a case is encountered, use of multislice computed tomography (MSCT) to examine the temporal bone might help to confirm the diagnosis and the integrity of the stapes [6], [7], [8], [9], [10].
We report a case of a traumatic perilymphatic fistula with luxation of the stapes into the vestibule that was diagnosed using CT. We discuss the diagnosis and treatment in the current case and compare it with previous reports from the literature.
Section snippets
Case
A 40-year-old male was admitted to our neighborhood clinic suffering from severe pain and hearing loss in his right ear. The symptoms occurred immediately after suffering a traumatic injury caused by an earpick. The tympanic membrane exhibited a small perforation and an audiogram demonstrated mild mixed hearing loss (air conduction threshold 40 dB) with a slight increase of the bone conduction threshold in his right ear. Two days later, he suffered vertigo with nausea, and a pure tone audiogram
Discussion
Traumatic luxation of the stapes into the vestibule is a rare complication seen in penetrating middle ear injury [1], [2], [3], [4], [5]. While fracture of the stapes is not uncommon, it is seldom accompanied by an intact stapes that is deeply depressed into the vestibule [6], [7], [8]. Because the prognosis of inner ear function and any required treatment are markedly influenced by the condition of the stapes, it is important to be able to precisely evaluate the condition of the middle and
Conclusion
In a 40-year-old male suffering from traumatic perilymphatic fistula caused by an earpick, MSCT clearly demonstrated the presence of air and full depression of the stapes into the vestibule. MSCT was very useful for evaluating the condition of the stapes preoperatively. Surgical treatment was successfully performed and involved closure of the fistula without removing the stapes in the vestibule in order to avoid any additional damage to the membranous labyrinth.
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Imaging of the temporal bone following otologic and lateral skull base trauma
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2019, Neuroimaging Clinics of North AmericaCitation Excerpt :Any concurrent or alternate pathology that may present with similar findings, such as semicircular canal dehiscence, would be critical knowledge before surgical intervention, as all sources of perilymphatic fluid leak should be addressed concurrently. One relatively rare and complicated clinical scenario in which the radiologist can add value is the setting of traumatic stapes dislocation into the vestibule as a cause of PLF, often the result of penetrating trauma.24,25 There is no standard of care for when to perform surgery or whether to remove the dislocated stapes from the vestibule; those that advocate for early removal are concerned about scar tissue that may develop in the vestibule and lead to late inner ear injury, while those that caution against removal are concerned about the risk of sensorineural hearing loss.24
Pneumolabyrinth: An atypical complication in a cochlear implant
2016, Acta Otorrinolaringologica EspanolaPneumolabyrinth after cochlear implantation in large vestibular aqueduct syndrome: A case report
2011, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :Pneumolabyrinth as a radiologic sign of a perilymphatic fistula was first reported by Mafee et al [1] shortly after the invention of high-resolution computed tomography (HRCT). The intrusion of air into the inner ear has been described as a complication of petrous bone fractures [2] mostly after direct manipulative trauma to the tympanic membrane, often in combination with a displacement of the stapes into the vestibule [3]. It has also been reported as an iatrogenic complication after stapes surgery, particularly after a stapedectomy [4,5].
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