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Cholesteatoma surgery with labyrinthine fistula

Presenting Author: Tommaso Sorrentino

Published online by Cambridge University Press:  03 June 2016

Tommaso Sorrentino ,
Nader Nassif ,
Francesco Mancini  and
Luca Redaelli DeZinis
Tommaso Sorrentino
Affiliation:
Spedali Civili Brescia
Nader Nassif
Affiliation:
ENT Department Spedali Civili Brescia
Francesco Mancini
Affiliation:
ENT Department Spedali Civili Brescia
Luca Redaelli DeZinis
Affiliation:
ENT Department Spedali Civili Brescia
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Abstract

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Learning Objectives: To give suggestions on the treatment of labyrinthine fistula in cholesteatoma surgery and the risk of hearing loss.

Introduction: Labyrinthine fistula is one of the most common complications of chronic otitis media with cholesteatoma. The aim of this study is to identify factors that may foresee evolution of hearing in case of cholesteatoma surgery with labyrinthine fistula.

Methods: We did a retrospective study on patients undergone tympanoplasty for cholesteatoma with labyrinth fistula. For each case were noted localization/s and the features of the fistula, treatment of the cholesteatoma and the fistula, and air and bone conduction thresholds before and after surgery.

Results: 75 ears has been evaluated. Only for 26.7% of the patients complained about hearing loss at diagnosis, while all but 3 patients presented hearing loss at audiometric testing. The fistula interested the lateral semicircular canal in 81.3%, while interest multiple canals in 18.7% of the cases. The fistula was membranous in 22.7 % cases, while bony in 77.3 % of cases. The size of the fistula was inferior to 2 mm in 60% of the patients, and superior to 2 mm in 40%. Only 21.3% patients underwent canal wall up , while 78.7% underwent canal wall down tympanoplasty. In 33.3% of the cases the matrix of the cholesteatoma was left in place on the fistula. In the other cases it was remouved and the fistula was covered. In 17.3% of cases we don't have details. The mean preoperative bone conduction thresholds was 30.8 dB. The mean postoperative bone conduction thresholds was 35.3 dB. Hearing loss was more significant at 1 and 2 Khz. The risk of hearing loss was statistically correlated to the presence of multiple, membranous fistulae and if the size of the fistula was superior to 2 mm.

Conclusions: In case of labyrinthine fistula the risk of hearing loss is not correlated to the surgical procedure, but mainly on the feature of the fistula. Probably in case of large, multiple fistulae the membranous labyrinth may be damaged not only by surgery but also by inflammatory and infective process.