Post-Traumatic Pneumolabyrinth Following Penetrating Trauma: A Case Report and Review of Literature

: Introduction and importance Pneumolabyrinth is a rare condition defined by the presence of air within the inner ear most often identified on imaging and considered pathognomonic for a perilymphatic fistula. Beyond its radiological features, it represents a clinically significant entity associated with acute audiovestibular symptoms. PNL secondary to penetrating trauma is exceedingly uncommon, with only a limited number of cases reported in the literature. Given its rarity, the clinical presentation, diagnostic approach, and optimal management remain subjects of debate, with no established therapeutic consensus. Case presentation We report the case of a 50-year-old male patient, who consulted our ENT department for otorrhagia following penetrating trauma to the left ear caused by a metallic wire, associated with severe vertigo and hearing loss. Otoscopic examination revealed active bleeding and a large central perforation of the left tympanic membrane. Pure-tone audiometry demonstrated a moderate mixed hearing loss. CT scan showed a subluxation of the ossicular chain associated with pneumovestibule, and a bone fragment incarcerated within the vestibule. The patient was managed conservatively with close clinical follow-up. Clinical discussion Pneumolabyrinth is a rare radiological finding, particularly following penetrating trauma. Management remains non-standardized due to the limited number of reported cases; however, conservative treatment is commonly adopted and includes bed rest with head elevation, avoidance of Valsalva maneuvers, systemic corticosteroids, antibiotic prophylaxis, and close clinical and radiological follow-up. This approach is often effective, with vestibular symptoms generally showing better recovery than hearing outcomes, especially when intralabyrinthine air involves the cochlea. Conclusion Post-traumatic pneumolabyrinth is a rare entity that may present with severe audiovestibular symptoms. Nevertheless, conservative management can be effective in selected cases, provided that careful clinical evaluation, appropriate imaging, and close follow-up are ensured to avoid unnecessary surgical intervention.