Management of labyrinthine fistulae in chronic ear surgery

Copeland, Benjamin J.; Buchman, Craig A.

doi:10.1053/ajot.2003.10

Cited by 72 publications

(89 citation statements)

References 28 publications

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“…With an incidence of around 7% [15], labyrinthine fistula still represents the most frequent complication of chronic otitis media with cholesteatoma. The most commonly sites affected are the lateral semicircular semicircular canals, followed by the superior and the posterior canals.…”

Section: Discussionmentioning

confidence: 99%

Preserving bone conduction in patients with labyrinthine fistula

Gocea

Martinez-Vidal

Panuschka

et al. 2011

Eur Arch Otorhinolaryngol

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The management of labyrinthine fistula is a controversial issue. Hearing preservation represents a major challenge. Retrospective study of 31 patients with labyrinthine fistula confirmed intra-operatively during cholesteatoma surgery. In all cases, total matrix removal was performed, and the fistula covered with bone dust, periostium and/or cartilage. Twenty-five patients received a high intra-operative dosage (500 mg) of intravenously applied steroids at least 15 min before handling the fistula. Outcome measurements included comparison of the pre-operative and post-operative bone conduction to assess inner ear function. The results were, the fistula was located in the lateral semicircular canal (LSC) in 22 patients (71.8%) and in the oval window in eight. One patient had a double localization in the superior and lateral semicircular canals. Out of the LSC fistulas, five patients (16.12%) had a fistula type I, 8 had type IIa (25.8%), four (12.9%) type IIb, and six patients type III (19.35%). Three out of eight patients with fistula located in the oval window had a total absence of the footplate, other four presented a partial anterior resorption at the level of the fissula antefenestram and the remaining one had a fractured platina. Pre-operatively, the bone conduction displayed a mean threshold of 35 dB. Twenty-two (85%) out of 26 patients treated intra-operatively with steroids showed preservation or improvement of bone conduction. Patients with fistulas of the oval window, type I, IIa and III fistulas in the LSC treated with cortisone presented good sensorineural hearing outcome (preservation or significant improvement of inner ear function in the majority of cases-91%); the auditory results for group IIb were inconclusive. Five patients did not receive steroids, four of them developed partial sensorineural hearing loss and one went deaf. To conclude, cholesteatoma surgery with a single-staged matrix removal on perilymphatic fistulas, after intra-operative intravenous administration of a high dosage of steroids followed by a multilayer closure of the fistula achieved a hearing preservation or improvement in 85% of our patients.

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Section: Discussionmentioning

confidence: 99%

Preserving bone conduction in patients with labyrinthine fistula

Gocea

Martinez-Vidal

Panuschka

et al. 2011

Eur Arch Otorhinolaryngol

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“…Its incidence varies between 4 and 12%, with a predilection for the horizontal semicircular canal (SCC) representing 66-90% of Wstulas [1][2][3][4][5][6]. Hearing loss (90%), otorrhea (65%) and dizziness (50%) are the most frequent presenting symptoms [7].…”

Section: Introductionmentioning

confidence: 99%

Prognostic indicators of hearing after complete resection of cholesteatoma causing a labyrinthine fistula

Stephenson¹,

Saliba

2011

Eur Arch Otorhinolaryngol

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The objectives of this study are (1) to evaluate hearing change after complete cholesteatoma resection in the setting of a labyrinthine fistula, (2) to assess the sensitivity and specificity of the preoperative CT-scan in diagnosing a labyrinthine fistula, and (3) to determine the correlation between the type of the labyrinthine fistula and its radiologic size. A retrospective chart review of all patients operated for cholesteatoma between 2004 and 2009 was conducted. Primary outcome was defined as the average variation in bone conduction thresholds (BCTs) as well as speech discrimination score (SDS) after total excision of cholesteatoma causing a labyrinthine fistula. We reviewed all preoperative CT-scans and operative notes to assess sensitivity and specificity for the diagnosis of a labyrinthine fistula. Results show that 317 patients underwent mastoidectomy for cholesteatoma. Twenty-eight patients were found to have 32 labyrinthine fistulas caused by cholesteatomatous disease affecting the lateral semi-circular canal (SCC) (n = 25), the superior SCC (n = 5), the posterior SCC (n = 1) and the footplate (n = 1). Postoperative BCT and SDS (24.5 dB; 86.6%) were neither clinically nor statistically different from preoperative levels (23.2 dB; 87.5%) (p = 0.35). Sensitivity and specificity of the preoperative high resolution 0.55 mm cuts CT-scan was 100%. With a fistula of 3.55 mm in the axial plan, a membraneous fistula must be suspected with a sensitivity of 66% and a specificity of 71%. Complete matrix resection without suctioning at the site of a cholesteatomatous labyrinthine fistula is a safe and effective management option. High-resolution preoperative CT-scan is very precise in diagnosing labyrinthine fistula and its radiologic size helps to predict the type of the fistula.

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“…Fortunately, the incidences of such complications have been reduced by early treatment and the use of antibiotics, but it should be noted that labyrinthine fistula may occur without symptoms. Many studies have been conducted on the frequency of labyrinthine fistula caused by cholesteatoma, and although findings differ, reported frequencies of are ~7% for patients with chronic otitis media with cholesteatoma [7] .…”

Section: Discussionmentioning

confidence: 99%

“…Size is defined as the diameter of bone erosion, and it has been reported that if the size of a fistula is less than 2 mm, the possibility of a damaged membranous labyrinth is low, because the cholesteatoma matrix is limited to the region of bone destruction [7] . On the other hand, Palva et al and Quaranta et al [10,12] found that the prognosis of labyrinthine fistula was correlated with invasion depth rather than fistula size.…”

Section: Discussionmentioning

confidence: 99%

“…Others have found that an intraoperative corticosteroid injection aids hearing preservation [7,15,20] . At the time of operation, surgeons removed all cholesteatoma matrix (except that overlying fistulas), and injected corticosteroid (methyl prednisolone 500 mg, intravenous) 15 minutes prior to treating the fistula site and again 2 days after surgery.…”

Section: + -mentioning

confidence: 99%

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Preservation of Post Operative Bone Conduction Hearing after Labyrinthine Fistula Repair in Chronic Otitis Media with Cholesteatoma: A Review of 23 Cases

Cho¹,

Yang²,

Aum³

et al. 2014

Int Adv Otol

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OBJECTIVE:Labyrinthine fistula can lead to hearing loss, dizziness, and intracranial complications. The management of labyrinthine fistula is controversial, and hearing preservation represents a major challenge. In this study, the authors sought to identify factors related to postoperative bone conduction threshold. MATERIALS and METHODS:This retrospective study was conducted using the clinical records of 23 cases operated on for chronic otitis media with cholesteatoma from 2004-2011. Symptoms, physical examination finings, fistula test results, pre-/postoperative bone conduction results, and high-resolution temporal bone computed tomograpghy and intraoperative findings were evaluated. RESULTS:The most common symptom at presentation was hearing disturbance, and the most commonly affected site was the lateral semicircular canal. High-resolution temporal bone computed tomograpghy was found to be much more precise and effective at fistula detection than the fistula test. CONCLUSION:Postoperative hearing results are not affected by fistula location, size, or number. Complete resection at the site of a cholesteatomatous labyrinthine fistula is the treatment of choice.

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Management of labyrinthine fistulae in chronic ear surgery

Cited by 72 publications

References 28 publications

Preserving bone conduction in patients with labyrinthine fistula

Preserving bone conduction in patients with labyrinthine fistula

Prognostic indicators of hearing after complete resection of cholesteatoma causing a labyrinthine fistula

Preservation of Post Operative Bone Conduction Hearing after Labyrinthine Fistula Repair in Chronic Otitis Media with Cholesteatoma: A Review of 23 Cases

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