Mastoid pneumocele with secondary pneumatocele causing external auditory canal obstruction and the influence of forced nose blowing.
We present a case involving a 36-year-old man who had a feeling that his right ear was obstructed and who had associated conductive hearing loss that was exacerbated by nose blowing. On otoscopy, a soft-tissue swelling was seen in the posterosuperior aspect of the right external auditory canal. Computed tomography revealed the presence of hyperaerated mastoid air cells and an air-containing cavity connected with the enlarged mastoid air cells, narrowing the external auditory canal. A radiographic diagnosis of a mastoid pneumocele with secondary pneumatocele was made. A novel hypothesis is presented, that high nasal pressures play an important role in the progressive formation of a pneumocele/pneumatocele as a result of air invasion via the eustachian tube. Symptoms disappeared after a myringotomy tube was placed. Computed tomography performed 6 months later showed an impressive remodeling of the temporal bone.
Department of Otorhinolaryngology, Head and Neck Surgery, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
Geert
G
Delabie
Frans
F
Gordts
Peter A R
PA
Clement
D000328:Adult; D000388:Air; D003251:Constriction, Pathologic / Q000503:physiopathology*; D004424:Ear Canal / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008416:Mastoid / Q000503:physiopathology*; D009296:Nasal Cavity