Management of labyrinthine fistulas in cholesteatoma.
Surgical management of labyrinthine fistulas caused by cholesteatoma remains controversial. In 213 patients with middle ear surgery for cholesteatoma, 18 patients (18 ears-8.5%) presented a labyrinthine fistula. These cases are reviewed in the present paper. Symptoms, audiometry, pre-operative imaging, surgical procedure and results are discussed. In all cases total removal of the pathology was pursued with preservation of cochlear function. A two-stage closed technique was used. During the first stage reconstruction with tympano-ossicular allografts, according to the technique of J. Marquet, was performed. A second look followed one year later. Three ears were deaf pre-operatively. Improvement of bone conduction was observed in more than 50% and hearing preservation in all other cases but one. In one ear total deafness occurred from extensive intralabyrinthine invasion by cholesteatoma, demanding a labyrinthectomy. The hearing was preserved in four cases in which an amputation of a large part of the membranous labyrinth could be observed. Since neither pre-operative clinical examination nor imaging can be relied on to reveal a fistula, the surgeon needs to be prepared for unexpected fistulas.
Vanden Abeele
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Department of Otorhinolaryngology, Head and Neck Surgery, M I St Augustinus, Antwerp University, Belgium.
Offeciers
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D000293:Adolescent; D000328:Adult; D002648:Child; D002781:Cholesteatoma / Q000150:complications*; D005260:Female; D005402:Fistula / Q000150:complications / Q000601:surgery*; D006801:Humans; D007759:Labyrinth Diseases / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013514:Surgical Procedures, Operative / Q000379:methods