title: Surgery for Cholesteatomatous Labyrinthine Fistula.
abstract: OBJECTIVE
  There is uncertainty regarding the ideal surgical management of cholesteatomatous labyrinthine fistulae. The objective was to review the published evidence to determine whether a difference exists in hearing outcome for cholesteatoma matrix removal or matrix exteriorization.
  
  
  METHODS
  Systematic MEDLINE and Web of Science searches identified publications describing hearing results after cholesteatoma matrix removal or matrix exteriorization.
  
  
  METHODS
  Three reviewers appraised the studies for quality, level of evidence, and extracted data. Fistula characteristics such as single-site, multisite, size, grade, and follow-up time were extracted for subanalyses, and when appropriate, data were pooled for statistical analysis.
  
  
  RESULTS
  Twenty-eight articles met inclusion criteria, and the level of evidence was judged no better than level 3b. There was no difference in hearing preservation detected between matrix removal and exteriorization (87% for matrix removal, 95% CI, 0.82-0.90; 95% for exteriorization, 95% CI, 0.85-0.98). An analysis of the individual cohort studies that compared these groups directly did not show a difference in calculated odds ratio (OR), 0.96 (95% CI, 0.66-1.40).
  
  
  CONCLUSIONS
  The level of evidence on which to base surgical decision making related to cholesteatomatous labyrinthine fistula is poor, and the data do not demonstrate significant differences in hearing outcomes based on surgical technique.
authors.affiliation: 1 University of Chicago, Section of Otolaryngology-Head & Neck Surgery & Pritzker School of Medicine, Chicago, Illinois, USA.
authors.forename: John
authors.initials: J
authors.lastname: Lim
authors.affiliation: 1 University of Chicago, Section of Otolaryngology-Head & Neck Surgery & Pritzker School of Medicine, Chicago, Illinois, USA.
authors.forename: Anupriya
authors.initials: A
authors.lastname: Gangal
authors.affiliation: 1 University of Chicago, Section of Otolaryngology-Head & Neck Surgery & Pritzker School of Medicine, Chicago, Illinois, USA.
authors.forename: Michael Brian
authors.initials: MB
authors.lastname: Gluth
mesh_terms: D002781:Cholesteatoma / Q000601:surgery*; D004427:Ear Diseases / Q000601:surgery*; D007758:Ear, Inner; D005402:Fistula / Q000601:surgery*; D006801:Humans
keywords: cholesteatoma; hearing outcomes; labyrinthine fistula; mastoidectomy; otolaryngology; otologic surgical procedures; otology