Endoscopic repair of a temporal bone pneumatocele

Objective: Pneumatoceles of the temporal bone are rare entities. A symptomatic external auditory canal pneumatocele repaired endoscopically is demonstrated. Methods: A 79-year-old man presented with fluctuating hearing loss and difficulty wearing in-ear hearing aids. The patient had two previous tube insertions which both failed within days. Examination of the left ear revealed a cyst filling the superior aspect of the lateral canal and obscuring the view of the majority of the tympanic membrane. Pre-op audiogram demonstrated a symmetric bilateral mild to moderate sensorineural hearing loss. The patient underwent a transcanal endoscopic composite cartilage myringoplasty. On incising the pneumatocele, a pars flaccida defect was identified in continuity with the pneumatocele. After excising the pneumatocele, a posterosuperior based tympanomeatal flap was raised and the defect repaired with a composite tragal cartilage perichondrial graft. Results: The patient had an uneventful recovery. On first postoperative review, the tympanomeatal flap had healed and the cartilage graft was intact with partial integration and epithelialization. There was no evidence of pneumatocele recurrence and his existing hearing aids were able to be worn with satisfactory amplification. The formation of the pneumatocele was presumed secondary to a ball-valve effect of skin through the pars flaccida defect and progressive raising of the epithelial layer in continuity with the canal skin. Conclusion: Surgical repair of temporal bone pneumatoceles is warranted in symptomatic patients. Identifying and addressing the underlying cause of their development is essential to surgical management.SDC video link: http://links.lww.com/MAO/B267.