Labyrinthine fistula after cholesteatomatous chronic otitis media.
OBJECTIVE
To report on cases of labyrinthine fistula diagnosed in an ear, nose, and throat department and to study the incidence, location, pre- and postoperative symptoms (hearing loss, tinnitus, vertigo, facial palsy), preoperative diagnostic imaging, and surgical treatment of two types of cholesteatomatous labyrinthine fistulae-the extensive fistula that erodes both the bony and membranous labyrinths and the bone fistula that affects only the bony labyrinth.


METHODS
Retrospective case review.


METHODS
Fifty-four patients with cholesteatomatous chronic otitis media with labyrinthine fistulae.


METHODS
Tertiary referral center.


METHODS
Diagnosis and treatment.


METHODS
Clinical, imaging, and surgical correlation of extensive fistulae and bone fistulae.


RESULTS
The incidence of labyrinthine fistulae was 7% in all patients who underwent surgery for chronic otitis media. The bone type (66%) is more common than the extensive type (33%). Compared with bone fistulae, the outcome for extensive fistulae is more severe in terms of hearing loss, vertigo, and facial palsy. In terms of preoperative diagnosis, computed tomography imaging ensured early diagnosis in 89% of extensive cases and in 28% of bone cases. For extensive fistulae, the surgical technique was more radical, requiring an open technique in 66% of cases versus 22% of the bone fistulae cases. The most common location is the lateral semicircular canal (61%).


CONCLUSIONS
The breach in the membranous labyrinth is consistent with a more aggressive pathology, causing more severe pre- and postoperative symptoms. Preoperative computed tomography is more sensitive for diagnosing extensive fistulae, which also require a more radical treatment.
Gersdorff
M C
MC
ENT Department, Université Catholique de Louvain, University Hospital St-Luc, Brussels, Belgium.
Nouwen
J
J
Decat
M
M
Degols
J C
JC
Bosch
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000209:etiology*; D002908:Chronic Disease; D005402:Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007759:Labyrinth Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D008875:Middle Aged; D010033:Otitis Media / Q000150:complications*; D013506:Otologic Surgical Procedures / Q000379:methods; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome