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Pneumocephalus and orbital emphysema associated with the use of an autoinflation device: a unique case report and review of the literature

  • A J Millington (a1), V Perkins (a1) and M A Salam (a1)
Abstract
Background

Autoinflation devices are commonly used for otitis media with effusion and Eustachian tube dysfunction. Generally, these are very safe devices, with few or no complications.

Case report

This paper presents a case study of pneumocephalus and orbital emphysema, associated with the use of an autoinflation device, in a 73-year-old woman with Eustachian tube dysfunction and otitis media with effusion, and a history of extensive endoscopic sinus surgery 13 years previously.

Conclusion

A literature review showed autoinflation-related pneumocephalus in patients with skull base defects relating to cranial surgery or tumours; however, this has not been described previously with the Otovent system or its use in relation to functional endoscopic sinus surgery. Given the theoretical risk of undetected bony abnormalities in post-operative functional endoscopic sinus surgery patients, it is suggested that autoinflation devices are used cautiously in patients with a history of sinus surgery.

Copyright
Corresponding author
Author for correspondence: Mr Alexander Millington, c/o ENT Dept, Ipswich Hospital, Heath Road, Ipswich IP4 5PD, UK E-mail: dr.alexmillington@gmail.com
Footnotes
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Mr A Millington takes responsibility for the integrity of the content of the paper

Footnotes
References
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1Blanshard, J, Maw, A, Bawden, R. Conservative treatment of otitis media with effusion by autoinflation of the middle ear. Clin Otolaryngol Allied Sci 1993;18:188–92
2Stangerup, SE, Sederberg-Olsen, J, Balle, V. Autoinflation as a treatment of secretory otitis media. A randomized controlled study. Arch Otolaryngol Head Neck Surg 1992;118:149–52
3National Institute for Health and Care Excellence. Otovent nasal balloon for otitis media with effusion. Medtech innovation briefing [MIB59]. In: www.nice.org.uk/guidance/mib59 [30 December 2018]
4Perera, R, Glasziou, PR, Heneghan, CJ, McLellan, J, Williamson, I. Autoinflation for hearing loss associated with otitis media with effusion. Cochrane Database Syst Rev 2013;(5):CD006285
5Williamson, I, Vennik, J, Harnden, A, Voysey, M, Perera, R, Kelly, S et al. Effect of nasal balloon autoinflation in children with otitis media with effusion in primary care: an open randomized controlled trial. CMAJ 2015;187:961–9
6Nakazawa, M, Watanabe, N, Oyama, S-I, Takahashi, M, Murakami, S. A case of pneumocephalus caused by Valsalva's maneuver following eustachian tube dysfunction [in Japanese]. Jibi Inkoka Tembo 2003;46:289–93
7Nyrop, M, Bjerre, PK, Christensen, J, Jørgensen, KE. Extensive and symptomatic cranial pneumatization: caused by frequent performance of Valsalva's manoeuvre? J Laryngol Otol 1999;113:480–2
8Nishikiori, O, Akatsuka, T, Tabuchi, A, Yamashita, T, Akisada, T. A case of orbital emphysema and pneumocephalus discovered by ocular deviation and proptosis – otolaryngological procedure and metastatic orbital tumor as a rare etiology [in Japanese]. Folia Japonica de Ophthalmologica Clinica 1997;48:129–33
9Ishiguro, S. A case of pneumocephalus due to Eustachian tube inflation. Otolaryngology 1985;57:719–22
10Otovent Fly. In: https://www.otovent.co.uk/what-is-otovent-for/air-travel/ [30 December 2018]
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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