Last revised by Yahya Baba on 25 Dec 2022

Pneumolabyrinth refers to the presence of gas within the inner ear and is a sign of perilymphatic fistula in a trauma setting. It manifests in HRCT of the temporal bone as gas bubbles in the cochlea, vestibule or semicircular canals.

Pneumolabyrinth is not a rare finding following temporal bone trauma and is estimated to occur in 8% of all temporal bone fractures and almost 50% of otic capsule-violating temporal bone fractures 1.

Since a pneumolabyrinth is usually associated with a traumatic perilymphatic fistula, symptoms may include 2

  • temporal bone trauma is by far the most common cause with:
    • stapes subluxation
    • stapes fracture
    • otic capsule fracture
    • oval or round window membrane lesions
  • postoperative complication of middle ear surgery
    • stapedectomy
    • stapedotomy
    • cochlear implant
    • ossiculoplasty
  • barotrauma
  • chronic middle or inner ear inflammation such as:
    • cholesteatoma
    • tumors
  • otic capsule dehiscence

No specific treatment is described for pneumolabyrinth and patients with no significant hearing loss, or vestibular symptoms get conservative management with head elevation, absolute bed rest, and avoidance of the Valsalva maneuver.

Association with perilymphatic fistula, disabling symptoms or complete deafness require middle ear exploration and surgical sealing of the fistula 3.

Cochlear gas is typically associated with a poor prognosis for improvement in hearing loss, compared to pneumolabyrinths confined to the vestibule 4.

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