Surgical Management of Labyrinthine Fistula in 102 Patients with Cholesteatoma

Aims: This study presents our experience in surgical management of labyrinthine fistulas and improvement in hearing after ear reconstruction in 102 patients suffering from chronic otitis media with cholesteatoma.

Material and Methods: In a 15-year period, 102 patients (males 59, females 43) with a mean age of 43 years (range, 2 to 90 years) underwent an ear operation for labyrinthine fistula. Their clinical presentation included vertigo (57.8%), tinnitus (20.5%), and hearing loss (81.3%). Fistula test was positive in 59.8% of the patients. In all cases assessment was completed with a CT scan of the petrous bones. Location of the fistula was mainly in the horizontal semicircular canal (83 patients). The size of the fistula varied from small (< 1 mm, 30.5%), to moderate (1 to 2 mm, 47%), to large (> 2 mm, 22.5%). Canal wall up technique was used in 73 cases and canal wall down in 29 cases. Different materials were used during surgical repair (bone, perichondrium, temporalis fascia, tissue glue).

Results: The mean follow-up of the patients was 64 months. The vast majority of patients presented hearing preservation (48.5%) or hearing improvement (31.3%) postoperatively. Decreased hearing was found in 15.7% of patients and postoperative deafness reported in five patients (three of them had a large fistula).

Conclusion: Location and size of labyrinthine fistula are major criteria for the decision of the surgical plan. Large fistulas present higher incidence of postoperative hearing damage, and thus the proposed technique is the open cavity and removal of the matrix covering the site of the fistula in a second-look operation.