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Management of labyrinthine fistula in cases with cholesteatoma

Presenting Author: Rie Kanai

Published online by Cambridge University Press:  03 June 2016

Rie Kanai  and
Shin-ichi Kanemaru
Rie Kanai
Affiliation:
Medical Research Institute, Kitano Hospital
Shin-ichi Kanemaru
Affiliation:
Medical Research Institute, Kitano Hospital
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Abstract

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Learning Objectives: To introduce our management strategy for labyrinthine fistula caused by cholesteatoma

Purpose: Complete removal of matrix on fistula and preservation of bone conduction (BC) hearing level are required in cases with labyrinthine fistulae (LF) caused by cholesteatoma. The purpose of this study is to introduce our management strategy for LF caused by cholesteatoma.

Study Design: Retrospective medical chart review.

Patients and methods: Twenty patients with LF caused by cholesteatoma (M: F = 11 : 9, mean age: 62.8) were enrolled in this study. All patients were underwent tympanomastoidectomy with removal of cholesteatoma matrix on fistula between April 2009 and February 2016. Location and depth of fistulae, surgical procedure how to seal fistulae, and change in BC hearing level before and after surgery were analyzed.

Summary of Results: Distribution of fistulae locations were lateral semicircular canal (N = 16), superior semicircular canal (N = 1), and multiple organs (N = 3) which included two cases with cochlear fistulae. Depth of fistulae revealed erosion of bony labyrinthine with intact endosteum (N = 8), opened perilynphatic space with perilymph leakage (N = 8), and destruction of membranous labyrinth (N = 4). Fistulae were closed by multi−layered reconstruction using fascia, bone putty with or without bone tips in 12 cases, by single−layered reconstruction using fascia or bone putty in 7 cases. Two cases showed scaled−out BC hearing level preoperatively. Postoperative BC hearing level analysis showed improvement more than 20 dB in 2 cases, preservation in 13 cases, and decreased more than 10 dB in 3 cases. BC hearing level was maintained in most cases.

Conclusion: Removal of cholesteatoma matrix and sealing should be performed in one-stage procedure in LF, because its disease progression and additional infection may cause. We think that the multi−layered reconstruction of LF is desirable to prevent postoperative perilymph leakage and deterioration of BC hearing level.