A pneumolabyrinth as a rare cause of deafness of the last hearing ear

Cholesteatoma can cause numerous complications, including mastoiditis, meningitis, epi/subdural abscesses, labyrinth fistulas, paralysis of the facial nerve and cerebral venous sinus thrombosis. This case study shows a special type of labyrinth fistula with air entering the labyrinth and the cochlea.

Casereport of a 52-year-old patient who presented with a deafness of the last hearing left ear 3 days ago and a rotary vertigo with vomiting. Already in 2017, due to a cholesteatoma of the opposite side and consecutive deafness during labyrinth destruction, a remediation in the sense of a mastoidectomy with insertion of a dummy electrode into the cochlea was performed. In clinical examination, the eardrum appeared thickened and intact. There was also a III° loss nystagmus to the right. The tuning fork experiments according to Weber and Rinne could not be perceived. Inpatient admission to standardized prednisolone therapy was performed. A CT of the petrous bone showed a small cholestoma as cause for the corrosion of the horizontal arcuate duct with formation of a pneumolabyrinth. In the cMRI with contrast medium a missing fluid signal of the left cochlea and the arches was found.

In speech audiometry there was no numerical or monosyllabic comprehensibility at 100 dB. Neither TEOAE nor DPOAE (1.5 - 6.0 kHz) were detectable. The video head impulse test showed a pathological gain of -0.05 bds. of the lateral arcuate duct. oVEMPs were bds. not detectable, cVEMPs could not be triggered either.

The case shows the possible serious effects of radiologically small cholesteatoma and the importance of modern imaging for the assessment of the cause of surdity.

Poster-PDF A-1871.PDF

Publication History

Article published online:
10 June 2020