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Pneumocephalus, hearing loss, and vertigo after airline flight in a patient with superior canal dehiscence.

Dramatic ambient pressure changes experienced during air travel can rarely result in sudden-onset vertigo and hearing loss if air enters the vestibule. Pressure changerelated pneumolabyrinth has been previously described as an implosive fistula (1). Rapid change in pressure within the middle ear is thought to cause a fracture at the stapes footplate resulting in ‘‘microfistula’’ through which air can travel to enter the vestibule, cochlea, and semicircular canals. Patients who have chronic Eustachian tube dysfunction and an intact tympanic membrane are at higher risk of fistula during ambient pressure changes. Superior semicircular canal dehiscence (SSCD) has been observed in pathologic studies of the temporal bone in as many as 2% of specimens (2). Only a subset of these patients will have vestibular and/or auditory complaints and meet diagnostic criteria for SSCD syndrome (3). Vestibular complaints are thought to be related to pressure from the middle ear or middle cranial fossa upon the exposed neuroepithelium of the exposed superior canal. Pneumolabyrinth in a patient with SSCD has not been previously described. We describe the case of a patient presenting with acute onset vertigo and hearing loss secondary to pressure changes during an airline flight. Computed tomographic (CT) scan findings included pneumolabyrinth, SSCD, and a small amount of ipsilateral pneumocephalus.