Late perilymphatic fistula with pneumolabyrinthitis in a patient with previous stapedotomy and obstructive sleep apnea: A case report

Background: Concerns with barotrauma after otologic surgery are well-established, but rarely is continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) considered despite evidenced impacts on middle ear pressure. With increasing CPAP use, it is vital to investigate CPAP's role in middle ear physiology and otologic barotrauma. Case presentation: A 47-year-old male presented with sudden complete right hearing loss. He had a history of bilateral otosclerosis treated with bilateral stapedotomies years prior. His right ear required revision complicated by otitis media and bacterial labyrinthitis. His hearing had been stable for years prior to the sudden loss. Initial treatment was antibiotics and nasal steroids for presumed otitis media. Medical history confirmed OSA treated with CPAP.Otoscopy demonstrated intact ear drums without middle ear fluid. No nystagmus was observed. An audiogram demonstrated worsened right mixed hearing loss. Oral corticosteroids were prescribed, and a temporal bone computed tomographic (CT) scan was ordered. The patient's hearing did not improve, and the CT scan demonstrated a well-positioned stapes prosthesis and air in the vestibule consistent with pneumolabyrinth.The patient was offered hearing aids, exploratory middle ear surgery, or cochlear implantation. He elected for cochlear implantation. CPAP was suspended postoperatively. After activation, his hearing improved dramatically. Six-month postoperative CT scan demonstrated no pneumolabyrinth. Conclusions: Postoperative CPAP utilization confers increased risk of barotrauma and warrants prolonged vigilance for complications in patients undergoing stapedotomy. Otologists should consider CPAP's role in sudden hearing loss after otologic surgery. Further investigation into the physiology of CPAP and pneumolabyrinth is warranted.