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Treatment using diffuse laser energy of cochlear and vestibular fistulas caused by cholesteatoma

  • S Basu (a1) and J Hamilton (a1)
Abstract
Objective

To measure the outcomes of laser treatment of cholesteatoma covering cochlear and vestibular fistulas.

Methods

Cholesteatoma matrix over the fistula was denatured; the power density was sufficient only to gradually heat, but not vaporise, the keratin-forming matrix. The denaturing speed was controlled so that the integrity of the fistula cover was maintained. The change in bone conduction threshold and the residual rate of cholesteatoma at the fistula were measured.

Results

Thirty-six fistulas were assessed. There were seven cochlear fistulas. All were 5 mm or less in maximum length. For the entire group, the average change in bone conduction threshold was −0.3 dB. For cochlear fistulas, the average change in bone conduction was + 0.2 dB. The distribution of hearing results for the entire group was Gaussian; the apparent changes in hearing could be attributed to errors associated with testing. All patients underwent second-stage surgery. In all cases, the cholesteatoma was completely cleared from the fistula site. There were no facial palsies.

Conclusion

Laser denaturing of cholesteatoma matrix over fistulas measuring 5 mm or less of vestibular apparatus and the cochlea is effective at eliminating cholesteatoma, and is not associated with cochlear hearing loss or facial palsy.

Copyright
Corresponding author
Author for correspondence: Mr John Hamilton, Dept. of ENT Surgery, Gloucestershire Hospitals NHS Trust, Great Western Road, Gloucester GL1 3NN, UK E-mail: john.hamilton7@nhs.net
Footnotes
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Mr J Hamilton takes responsibility for the integrity of the content of the paper

Footnotes
References
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7Hamilton, JW. Systematic preservation of the ossicles in cholesteatoma surgery using a fibre-guided laser. Otol Neurotol 2010;31:1104–8
8American Academy of Otolaryngology – Head and Neck Surgery Foundation. Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. Otolaryngol Head Neck Surg 1995;113:186–7
9Ikeda, R, Kobayashi, T, Kawase, T, Oshima, T, Sato, T. Risk factors for deterioration of bone conduction hearing in cases of labyrinthine fistula caused by middle ear cholesteatoma. Ann Otol Rhinol Laryngol 2012;121:162–7
10Katsura, H, Mishiro, Y, Adachi, O, Ogino, K, Daimon, T, Sakagami, M. Long-term deterioration of bone-conduction hearing level in patients with labyrinthine fistula. Auris Nasus Larynx 2014;41:69
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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