Post-Traumatic Cochlear and Vestibular Pneumolabyrinth - Case Report - Clinical Question, Findings, and Prognosis

Sep 28, 2026

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Cochlear pneumolabyrinth is a strong radiologic marker of irreversible hearing loss after otic capsule trauma. While vestibular symptoms may resolve spontaneously, cochlear air reliably predicts poor auditory recovery. Early computed tomography confirmation supports counseling and timely evaluation for hearing rehabilitation or cochlear implantation, even when surgery is not indicated. The clinical course examines prognosis when pneumolabyrinth involves both the cochlea and semicircular canals following head trauma.

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Clinical Question

Case Description

Answer and Discussion

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Author Contributions

Clinical Case Reports CASE IMAGE OPEN ACCESS Post-Traumatic Cochlear and Vestibular Pneumolabyrinth Santiago Almanzo1,2 | Catalina Bancalari-Díaz1 | Miguel Saro-Buendía1,2 | Vanesa Pérez-Guillén1 | Abel Guzmán-Calvete1 | Miguel Armengot-Carceller1,2 | Carlos De Paula-Vernetta1,2 1Department of Otolaryngology, Hospital Universitari i Politècnic La Fe, Valencia, Spain | 2Department of Surgery, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain Correspondence: Santiago Almanzo (almanzo@alumni.uv.es) Received: 5 July 2025 | Revised: 4 December 2025 | Accepted: 9 December 2025 Keywords: cochlear trauma | pneumolabyrinth | sensorineural hearing loss | temporal bone fracture | vestibular dysfunction | ABSTRACT
Cochlear pneumolabyrinth is a strong radiologic marker of irreversible hearing loss after otic capsule trauma. While vestibular symptoms may resolve spontaneously, cochlear air reliably predicts poor auditory recovery. Early computed tomography confirmation guides counseling and timely evaluation for hearing rehabilitation or cochlear implantation, even when surgical exploration is not indicated. | | | --- | --- | | 1 | Clinical Question | The patient was admitted and received intravenous methylprednisolone (1 mg/kg/day for 5days) followed by oral tapering | | What is the prognosis of pneumolabyrinth affecting both co- | over 3 weeks, alongside prophylactic antibiotics. Surgery was | | chlea and semicircular canals following head trauma? | not indicated because neither the fracture configuration northe clinical course suggested an active perilymphatic fistula. Exploratory tympanotomy is generally reserved for patients | | 2 | Case Description | with persistent or progressive symptoms. Vestibular symptoms resolved, but hearing remained profoundly impaired. A | | A 21-year-old male presented after blunt occipital trauma during | cochlear implant was offered but declined. Vestibular recovery | | an assault. He reported sudden-onset vertigo, unsteadiness, and | was confirmed clinically through complete resolution of ver- | | right-sided hearing loss. Otoscopic examination revealed a right | tigo and imbalance; no follow-up objective vestibular tests were | | hemotympanum. Pure-tone audiometry showed profound sensorineural hearing loss (Figure 1A) . Video Head Impulse Test (vHIT) demonstrated decreased vestibulo-ocular reflex (VOR) | performed. | | gains in all right semicircular canals (Figure 1B) . | 3 | Answer and Discussion | | High-resolution computed tomography (CT) of the temporal | Pneumolabyrinth is defined as the presence of air in the inner | | bone revealed a transverse fracture involving the right otic cap- | ear, typically due to a perilymphatic fistula from temporal bone | | sule. Air bubbles were detected in both the superior semicircular | trauma. It may also occur from non-traumatic causes, including | | canal (Figure 2A) and basal turn of the cochlea (Figure 2B), con- | iatrogenic and spontaneous perilymphatic fistulas. The location | | sistent with pneumolabyrinth. Facial nerve function was pre- | of air bubbles strongly correlates with prognosis: air confined to | | served. Magnetic resonance imaging (MRI) was not performed | the vestibular apparatus may be reversible, while air within the | | because CT findings were sufficient for management, although | cochlea—especially the basal turn—usually indicates permanent | | MRI may help identify intralabyrinthine hemorrhage or early | sensorineural hearing loss [1–3]. Prognosis is also influenced by | | fibrosis in selected cases. | air volume and associated injuries such as hemorrhage or early | | This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
© 2026 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd. | | Clinical Case Reports, 2026; 14:e71

FAQs

What does cochlear pneumolabyrinth indicate for hearing after otic capsule trauma?

It indicates irreversible hearing loss. Cochlear air on imaging predicts poor auditory recovery even if treatment is started early.

How can vestibular symptoms compare with hearing recovery in pneumolabyrinth?

Vestibular symptoms may resolve spontaneously. In contrast, hearing can remain profoundly impaired when cochlear pneumolabyrinth is present.

Why is computed tomography important in suspected pneumolabyrinth?

CT provides early confirmation and helps guide counseling and timely evaluation for hearing rehabilitation or cochlear implantation, which is crucial even when exploratory surgery is not indicated.

Sep 28, 2026

Uploaded by Jiven