Otogenic pneumocephalus.

Fifty-four previously reported cases of otogenic pneumocephalus were analyzed in addition to five new cases which are presented in detail. Forty-one males and 18 females were included with 95% of the patients being over 12 years of age. The most common presenting symptom was headache, and the ventricular system was the intracranial space most commonly involved. Tension pneumocephalus was present in 40 (66%) cases. Trauma (36%) was the most common etiologic factor, while otitis media (30%), otologic surgery (30%), and congenital defects (2%) accounted for the rest. The overall mortality was 12% with all patients succumbing to causes other than pneumocephalus. Because of its lack of specific symptoms, pneumocephalus was usually unsuspected and the diagnosis made only after radiographic evaluation. Despite its rarity, pneumocephalus has to be considered whenever the dura is violated, especially if associated with a CSF leak. Management depends on the degree of tension, symptomatology, and underlying cause. When associated with trauma or surgery, bedrest and close monitoring may suffice, although needle aspiration or re-exploration may be needed. When secondary to otitis media or a congenital defect, control of any infection and repair of the defect are mandatory.