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Cited by 0Vestibular and auditory disordersEar Surgery and Otitis MediaHearing, Cochlea, Tinnitus, Genetics

Complete Restored Hearing Loss after Excessive Nose Blowing with Various CT Findings

Open access
Koh, Ji Hoon, Lee, Eun Jung·2020·Korean Journal of Otorhinolaryngology-Head and Neck Surgery
DOI 10.3342/kjorl-hns.2020.00605
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Abstract

A perilymphatic fistula (PLF) is defined as leakage of perilymph with several possible causes such as superior canal dehiscence through trauma, temporal bone fracture, or sudden pressure change (e.g., skydiving or scuba diving). Pneumolabyrinth can result from temporal bone fracture after trauma, or sudden pressure change in the middle ear or cerebrospinal fluid, such as excessive nose blowing or Valsalva maneuver. A PLF and pneumolabyrinth may occur without trauma, associated with a sudden pressure change in the middle ear. We report two cases of PLF followed by pneumolabyrinth and one case of suspicious PLF without pneumolabyrinth after excessive nose blowing. All three cases were diagnosed as having sensorineural hearing loss and the patients recovered completely after conservative treatment. We report various CT findings of pneumolabyrinth and PLF, from normal CT findings to air pockets in the labyrinth and soft tissue density around the stapes.

AI snapshot

Written from the paper’s full text.

TL;DR

This case report describes three patients with sensorineural hearing loss after excessive nose blowing or sneezing, including two with perilymphatic fistula (PLF) and pneumolabyrinth and one with suspected PLF without pneumolabyrinth. All three recovered completely after conservative treatment, despite CT findings ranging from normal to air pockets in the vestibule and soft tissue density around the oval window.

Key findings

  • Case 1: a 15-year-old female with left hearing loss and vertigo 2 days after excessive nose blowing had a pure tone audiometry threshold of 22 dB for both bone and air conduction; CT showed multiple air pockets in the left vestibule. After high-dose steroid and broad-spectrum antibiotics, hearing improved to 8 dB air conduction and 5 dB bone conduction 8 days after admission, and follow-up CT showed the air pockets had disappeared.
  • Case 2: a 59-year-old female with right sudden hearing loss and vertigo 6 days after excessive nose blowing had an average threshold above 48 dB; CT showed soft tissue density around the oval window suggesting PLF. With high-dose steroid and absolute bed rest for 7 days, hearing improved only slightly to about 33 dB at discharge, but after 2 months the soft tissue density disappeared and hearing fully recovered to 5 dB.
  • Case 3: a 51-year-old male with left sudden hearing loss 5 days after excessive sneezing had an air conduction threshold of 31 dB; CT was normal. With high-dose steroid, broad-spectrum antibiotics, and bed rest, hearing improved to 9 dB at 14 days after admission.
  • The paper concludes that high-resolution temporal bone CT is useful for diagnosing pneumolabyrinth and PLF, but clinical symptoms remain important because air bubbles or fistula may be absorbed if imaging is delayed; initial management is conservative, with exploratory tympanotomy suggested for severe to profound sensorineural hearing loss over 70 dB or no improvement after 1–3 weeks of conservative treatment.

Methods

  • Design: case report/case series of three patients with hearing loss after excessive nose blowing or sneezing, without trauma.
  • Data: clinical history, otoscopic examination, vestibular function tests, pure tone audiometry, and high-resolution temporal bone CT before and after treatment; the study was approved by the Institutional Review Board (CUH 2020-02-043).
  • Analysis: descriptive reporting of individual cases and CT findings, with no formal statistical analysis.

Limitations

  • The paper does not include a formal limitations section. It states that PLF is not easy to identify through radiology, that it is not clear whether all PLF is accompanied by pneumolabyrinth, and that CT may be negative if delayed because air may have been absorbed.
  • Evident from the text: the findings are based on only three cases, with no control group or randomized treatment comparison, and follow-up periods and imaging timing differ across cases.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3342/kjorl-hns.2020.00605

Cites

10 of 10 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 2 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § Introduction

    All three cases were diagnosed as having sensorineural hearing loss.

    “All three cases were diagnosed as having sensorineural hearing loss and the patients recovered completely after conservative treatment.”
    Quote in the paperSubstantial claim
  • Findingown data
    § 125 250 500 1 K 2 K 4 K 8 K

    Case 3's high resolution temporal bone CT scan was normal.

    “A PLF was suspected, so a high resolution temporal bone CT scan was performed but the result was normal.”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Introduction

    All three patients recovered completely after conservative treatment.

    “All three cases were diagnosed as having sensorineural hearing loss and the patients recovered completely after conservative treatment.”
    Quote in the paperSubstantial claim
  • Findingown data
    § 125 250 500 1 K 2 K 4 K 8 K

    Case 3's pure tone audiometry 14 days after admission showed an improvement in hearing with an air conduction threshold of 9 dB.

    “Pure tone audiometry 14 days after admission showed an improvement in hearing with an air conduction threshold of 9 dB (Fig. 1C), and the patient was discharged.”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Introduction

    The CT findings of pneumolabyrinth and PLF varied from normal CT findings to air pockets in the labyrinth and soft tissue density around the stapes.

    “We report various CT findings of pneumolabyrinth and PLF, from normal CT findings to air pockets in the labyrinth and soft tissue density around the stapes.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 7
  • May combine two claims. 4

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § 125 250 500 1 K 2 K 4 K 8 K

    Case 3's otoscopic examination showed that both eardrums were normal.

    “Otoscopic examination showed that both eardrums were normal.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § 125 250 500 1 K 2 K 4 K 8 K

    Case 3 was a 51-year-old male who consulted with left-sided sudden hearing loss that occurred 5 days after excessive sneezing, with constant tinnitus and fullness of his ears.

    “A 51-year-old male patient consulted our department with left-sided sudden hearing loss. The symptom had occurred 5 days after excessive sneezing, and the patient had constant tinnitus and fullness of his ears.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Introduction

    Case 1 had a pure tone audiometry threshold of 22 dB for both bone and air conduction of the left ear.

    “Pure tone audiometry indicated a threshold of 22 dB for both bone and air conduction of the left ear (Fig. 1A).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Introduction

    Case 1 was a 15-year-old female who presented with hearing loss and vertigo after excessive nose blowing, commencing 2 days before visiting the department.

    “A 15-year-old female patient presented with hearing loss and vertigo after excessive nose blowing. This had commenced 2 days before visiting our department.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Introduction

    Two cases of PLF followed by pneumolabyrinth and one case of suspicious PLF without pneumolabyrinth occurred after excessive nose blowing.

    “We report two cases of PLF followed by pneumolabyrinth and one case of suspicious PLF without pneumolabyrinth after excessive nose blowing.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § 125 250 500 1 K 2 K 4 K 8 K

    Case 2 was a 59-year-old female who visited with sudden onset vertigo and hearing loss after blowing her nose excessively 6 days earlier.

    “A 59-year-old female patient visited our department with sudden onset vertigo and hearing loss. She had blown her nose excessively 6 days earlier, and whirling vertigo, aural fullness, tinnitus and sudden hearing loss had commenced.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § 125 250 500 1 K 2 K 4 K 8 K

    Case 2's otoscopic examination revealed a blood clot on the right tympanic membrane with granulation myringitis.

    “Otoscopic examination revealed a blood clot on the right tympanic membrane with granulation myringitis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 8 days after admission 2 months after outpatient follow-up 5 days after admission

    The treatment options for pneumolabyrinth are observation or explorative tympanotomy.

    “The treatment options are observation or explorative tympanotomy.7)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] source

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning
    § 8 days after admission 2 months after outpatient follow-up 5 days after admission

    In Case 3, the CT scan was performed several days after the initial symptoms, so the air may have been absorbed and dissipated.

    “The CT scan was performed several days after the initial symptoms, so the air may have been absorbed and dissipated.”
    Quote in the paperSubstantial claim
9 of 9

  • The paper relies on this without support.

    The recovery of hearing in the three cases was attributable to the conservative treatment rather than to spontaneous resolution.

    “All three cases were diagnosed as having sensorineural hearing loss and the patients recovered completely after conservative treatment.”
1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Case 3 is attributed to both sneezing and nose blowing

    Major

    The Case 3 narrative attributes the onset to excessive sneezing, while Table 1 records the Case 3 visit as occurring five days after nose blowing.

  • The number of cases with pneumolabyrinth changes

    Minor

    The abstract describes two cases with pneumolabyrinth and one without it. The introduction to the cases instead describes all three as PLF followed by pneumolabyrinth.

  • Case 1 tinnitus conflicts with the table

    Minor

    The Case 1 narrative lists tinnitus as an associated symptom, but Table 1 records no subjective symptom for Case 1 under tinnitus improvement.

  • Superior canal dehiscence is both included and excluded as PLF

    Minor

    The abstract names superior canal dehiscence among possible causes of PLF, whereas the introduction says leakage due to superior canal dehiscence is generally not considered PLF.

4 of 4

Cites

Flagged first, then by citations

Related

Authors
Koh, J. H., & Lee, E. J.
Affiliations
Jeonbuk National University Hospital (KR)
ORCID
Venue
Korean Journal of Otorhinolaryngology-Head and Neck Surgery
Publisher
Korean Society of Otorhinolaryngology-Head and Neck Surgery
Published
2020-12-21
Volume
63
Issue
12
Pages
620-624
ISSN
  • 1225-035X (ISSN-L)
  • 2092-5859
DOI
10.3342/kjorl-hns.2020.00605
OpenAlex
W3117376813
Semantic Scholar
521f703ae2f347bde5ec8918d0d1db1b77b2cff7
Cited by
0
References
10
FWCI
0.00
Type
journal article
Language
en
Open access
Licence
Locations
Korean Journal of Otorhinolaryngology - Head and Neck Surgery (publishedVersion, cc-by-nc)
Topics
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
  • Health Sciences › Medicine › Otorhinolaryngology › Ear Surgery and Otitis Media
  • Life Sciences › Neuroscience › Sensory Systems › Hearing, Cochlea, Tinnitus, Genetics
Keywords
perilymphatic fistula, pneumolabyrinth, sensorineural hearing loss, computed tomography findings, conservative treatment, hearing recovery

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-22.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-22.

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