Inner ear cholesteatoma and the preservation of cochlear function

Abstract

Labyrinthine destruction by direct cholesteatoma invasion has always been considered a serious threat to the inner ear function. A number of reports in the literature have cited both patients who had preservation of hearing despite widespread erosion of the labyrinth by cholesteatoma and patients who had retained auditory function despite surgical removal of the matrix from the labyrinth. In most cases the vestibular portion of the inner ear was invaded but cases of cochlear involvement have been described as well. Twelve cases with pre-operative auditory function preservation despite extensive labyrinthine destruction treated at our Institution are reported. Seven cases retained cochlear function post-operatively. Possible explanations of this occurrence and implications of related with hearing preservation in the presence of widespread inner ear destruction by chronic inflammatory disease are discussed.

Petrous Bone Cholesteatoma: Management and Outcomes

“…In 1969, Glasscock 8 described the middle cranial fossa (MCF) approach for various petrous bone lesions. This approach is used when the pathology is localized to the supralabyrinthine region with a serviceable hearing 9 . Posterior extension of this lesion necessitates a combined MCF–transmastoid approach.…”

“…This approach is used when the pathology is localized to the supralabyrinthine region with a serviceable hearing. 9 Posterior extension of this lesion necessitates a combined MCF-transmastoid approach. Transmastoid-retrolabyrinthine approach is appropriate for posterior lesions with limited superior extension.…”

Imaging of labyrinthine fistula after repair with bone pate

“…In this report, there is a single case with preoperative sensorineural loss showing hearing improvement, but most will remain stable or progress to anacusis. Invasion of the labyrinth also predicts greater chance of immediate postoperative hearing loss …”

“…Invasion of the labyrinth also predicts greater chance of immediate postoperative hearing loss. 12 Most prior reports discussing management of fistulae concentrate on intraoperative decision making including whether to attempt removal of squamous epithelium from the surface of the defect and what type of mastoidectomy is required. Consensus opinion indicates that manipulation of a cochlear fistula is associated with sensorineural hearing loss, whereas semicircular canal fistula appear to have the same risk of hearing loss with matrix removal or preservation.…”

Prise en Charge des Fistules Labyrinthiques Cholestéatomateuses: A Propos de 22 Cas

“…En revanche dans le cas où il existait une brèche du labyrinthe membraneux, la courbe osseuse 18 Ce phénomène semble confirmé par l'examen anatomo-pathologique post-mortem de rochers de patients ayant présenté une fenestration labyrinthique. 19 Chez six de nos patients (31%), la conduction osseuse s'est améliorée de 10 dB en moyenne, constatation également régulièrement rapportée dans la littérature (8.5% pour Parisier et collaborateurs, 10 11% pour Herzog et collaborateurs, 9 9% pour Magliulo et collaborateurs 8 ). Ce résultat serait obtenu par la disparition des phénomènes inflammatoires et infectieux locaux liée à l'ablation de la matrice.…”