Otolaryngology: Open Access
Open Access

Abstract

Pneumocephalus is defined as the presence of air within the cranial cavity, while tension pneumocephalus is a progressively expanding pneumocephalus with signs of raised intracranial tension. The commonest cause of pneumocephalus is head or craniofacial trauma; others common causes are tumor or infection. We discuss a case of spontaneous tension pneumocephalus which represents a diagnostic conundrum. A 35-year-old lady presented with sudden onset, severe occipital headaches, rightsided deafness and intermittent vertigo. She had been performing regular valsalva maneuver for past six weeks in order to improve her hearing. Neurological, ENT and fundoscopic examinations were unremarkable. Successive CT-scans of head revealed a gradually expanding extradural pneumocephalus in right parieto-occipital region, with minimal midline shift. Puretone audiometry revealed profound right-sided sensory neural hearing loss. Patient underwent right mastoid exploration to ascertain the cause of pneumocephalus. Intra-operatively the mastoid cavity was highly pneumatised. The middle-fossa dura and sigmoid sinus was fully exposed due complete absence of bony covering. The Eustachian tube opening in the middle ear was also unusually wide. Otogenic pneumocephalus results from temporal bone defects, in which air gains entry into the cranial cavity via middle ear or eustachian tube with pneumocephalus in middle and/or posterior cranial fossa. Spontaneous otogenic tension pheumocephalus is a rare complication of auto-insufflation for eustachian tube dysfunctions. Considering high prevalence of temporal bone defects (15-52% tegmen-tympani defects on autopsy and also a large number of patients with surgical bony defects as from cochlear implant surgery, clinicians should be aware of the risk and educate patients when needed.

Biography

Billy Wong is a core surgical trainee aiming to pursue Otolaryngology as a career. He has special interest in Paediatrics Otolaryngology and Head and Neck Surgery. He was a part of Addenbrooke?s Hospital for 12 months and published a number of articles during that period there.