One-Stage Complete Resection of Cholesteatoma With Labyrinthine Fistula: Hearing Changes and Clinical Outcomes

Rah, Yoon Chan; Han, Won Gue; Joo, Jae Woo; Nam, Kuk Jin; Rhee, Jihye; Song, Jae Jun; Im, Gi Jung; Chae, Sung Won; Jung, Hak Hyun; Choi, June

doi:10.1177/0003489418755407

Cited by 9 publications

(14 citation statements)

References 28 publications

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“…Preservation of bone conduction hearing threshold in ears with residual hearing was attained in 97% of the smaller-fistula group and 71% of the larger fistula group. Rah et al 9 also found a significant difference between fistula size and postoperative bone conduction threshold. SNHL may occur due to the loss of inner ear function as a result of iatrogenic injuries when the matrix over the labyrinthine fistula is completely removed.…”

Section: Discussionmentioning

confidence: 91%

“…All studies mentioned that a change of 10 dB or more in the bone conduction threshold was considered clinically significant. 1,5,[7][8][9] One of our cases had an average bone threshold conduction change of less than 10 dB at one month postoperative, which was considered as not clinically significant hearing deterioration based on the following literature. Ikeda et al 5 stated that poorer post operative bone conduction hearing was correlated with larger fistulae.…”

Section: Discussionmentioning

confidence: 94%

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Labyrinthine fistula size as a prognostic factor for postoperative hearing deterioration

Restuti

Priyono

Sriyana

et al. 2022

Oto Rhino Laryn Indones

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Background: A labyrinthine fistula is an abnormal opening in the bony capsule of the inner ear, such as cochlea or semi-circular canals that may occur as a complication of chronic suppurative otitis media (CSOM) with cholesteatoma. Purpose: To find out the relation of the size of labyrinthine fistula as a prognostic factor of hearing deterioration after a complete cholesteatoma removal. Case report: Two cases of labyrinthine fistula in CSOM with cholesteatoma, along with preoperative and postoperative audiometry results. Clinical question: Does the labyrinthine fistula size in CSOM with cholesteatoma patients could serve as a prognostic factor in the postoperative hearing outcome? Review method: A structured, evidence-based literature search using Pubmed, Proquest and Cochrane to find studies of labyrinthine fistula as a complication of CSOM. The articles were selected based on eligibility criteria i.e. surgery procedure, labyrinthine fistula measurement, and postoperative evaluation of hearing function. The appraisal of each article used Oxford critical appraisal independently for prognostic study and systematic review. Result: Two studies met the inclusion criteria. One article used cohort retrospective method valid based on appraisal for prognostic studies. The other article used a systematic review method which had low validity. Conclusion: Fistula size is still debatable as a postoperative prognostic factor for hearing deterioration in CSOM with cholesteatoma. Larger sample size and better methods of study are necessary to resolve the clinical question.Keywords: chronic suppurative otitis media (CSOM), cholesteatoma, labyrinthine fistula, fistula sizeABSTRAKLatar belakang: Fistula labirin adalah terbukanya dinding tulang pada koklea atau kanalis semisirkularis yang merupakan suatu komplikasi dari otitis media supuratif kronik (OMSK) tipe bahaya. Tujuan: Untuk menjawab pertanyaan klinis terkait hubungan antara ukuran fistula labirin dengan prognosis penurunan pendengaran pasca operasi pengangkatan kolesteatoma. Laporan kasus: Dua kasus fistula labirin pada penderita OMSK tipe bahaya, disertai dengan hasil pemeriksaan audiometri pendengaran sebelum dan sesudah operasi. Pertanyaan klinis: Apakah ukuran fistula labirin pada kasus OMSK dengan kolesteatoma dapat menjadi faktor penentu prognosis untuk hasil pemeriksaan pendengaran pasca operasi? Telaah literatur: Pencarian literatur berbasis bukti menggunakan Pubmed, Proquest dan Cochrane terkait fistula labirin pada kasus OMSK. Kriteria inklusi studi berdasarkan teknik operasi, ukuran fistula dan evaluasi pendengaran pasca operasi. Metode Oxford critical appraisal digunakan untuk studi prognosis pada satu artikel, dan digunakan systematic review untuk artikel lainnya. Hasil: Dari pencarian literatur terdapat dua artikel yaitu studi kohort retrospektif, dan systematic review yang memenuhi kriteria inklusi. Hasil telaah literatur menunjukan bahwa study kohort retrospektif memiliki validitas cukup baik, sedangkan studi systematic review memiliki validitas yang kurang baik. Kedua artikel ini memiliki hasil yang berbeda dalam hubungan ukuran fistula labirin dengan prognosis penurunan pendengaran pasca operasi. Kesimpulan: Ukuran fistula sebagai faktor prognosis penurunan pendengaran pasca operasi pada kasus OMSK tipe bahaya masih memerlukan penelitian dengan sampel yang lebih banyak, dan metode yang lebih baik untuk dapat menjawab pertanyaan klinis.Kata kunci: otitis media supuratif kronik (OMSK), kolesteatoma, fistula labirin, ukuran fistula

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 94%

Labyrinthine fistula size as a prognostic factor for postoperative hearing deterioration

Restuti

Priyono

Sriyana

et al. 2022

Oto Rhino Laryn Indones

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“…Among 947 patients affected by LF, a slight male prevalence was observed (pooled proportion, 55%; 95% CI, 51–59%; I 2 = 41%). Mean and median ages at diagnosis were quite heterogeneous, reported to be in the fourth decade by 7 studies (17,24,29,32,39,46,47), in the fifth by 9 (7,9,16,23,25,28,38,41,45), and in the sixth by 10 (10,11,26,27,31,33–35,37,43).…”

Section: Resultsmentioning

confidence: 99%

“…Although rather variable, canal wall down (CWD) or radical mastoidectomy were the most common procedures performed in most studies (2,9,10,(16)(17)(18)(24)(25)(26)(27)(28)(29)(30)(31)(32)(34)(35)(36)(37)(38)(39)(40)42,43,47), with a pooled proportion of 88% (95% CI, 79-94%; I 2 = 81%). LFs were most frequently located on the LSCC, with a pooled proportion of 90% (95% CI, 87-93%; I 2 = 46%).…”

Section: Characteristics Of Lfs and Surgical Managementmentioning

confidence: 99%

Presentation, Management, and Hearing Outcomes of Labyrinthine Fistula Secondary to Cholesteatoma: A Systematic Review and Meta-analysis

et al. 2022

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ObjectiveThe current study systematically reviewed the literature to compare auditory outcomes of patients treated for labyrinthine fistula (LF) based on characteristics of disease and surgical management.Databases ReviewedPubMed, Scopus, Web of Science.MethodsOriginal series (at least five cases) published from 2000 reporting management and hearing results of LF secondary to cholesteatoma were included. Proportion and odds-ratio (OR) meta-analyses were conducted through inverse variance random-effects models based on logit transformation.ResultsThe prevalence of LF is estimated to be 7% (95% confidence interval [CI], 5–9%). Fistulae involving the lateral semicircular canal (90%; 95% CI, 87–93%) and larger than 2 mm (53%; 95% CI, 43–64%) were common, whereas membranous involvement was less frequent (20%; 95% CI, 12–30%). Complete removal of the cholesteatoma matrix overlying the LF was mostly applied. Bone conduction (BC) preservation was frequently achieved (81%; 95% CI, 76–85%); new-onset postoperative anacusis was rarely reported (5%; 95% CI, 4–8%). A higher chance of BC preservation was associated with sparing the perilymphatic space (OR, 4.67; 95% CI, 1.26–17.37) or membranous labyrinth (OR, 4.56; 95% CI, 2.33–8.93), exclusive lateral semicircular canal involvement (OR, 3.52; 95% CI, 1.32–9.38), smaller size (<2 mm; OR, 3.03; 95% CI, 1.24–7.40), and intravenous steroid infusion (OR, 7.87; 95% CI, 2.34–26.42).ConclusionLF occurs in a significant proportion of patients with cholesteatoma. In the past two decades, complete removal of the cholesteatoma matrix followed by immediate sealing has been favored, supported by the high proportion of BC preservation. Hearing preservation depends primarily on characteristics of the LF, and specific surgical strategies should be pursued. Intraoperative and postoperative intravenous steroid infusion is recommended.

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“…25 Moreover, observational studies have shown that perilymph leakage during removal of the matrix or a high rate of postoperative bone conduction hearing loss is more likely to be found with deeper fistulae. 12,15,[26][27][28] Thus, removal of the matrix overlaying deeper labyrinth fistulae is presumed to carry a greater risk of irreversible hearing deterioration.…”

Section: Discussionmentioning

confidence: 99%

Imaging Analysis for Cholesteatoma Extension to the Perilymphatic Space in Labyrinth Fistulae

et al. 2020

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Objectives/Hypothesis: Disturbed perilymph behind a labyrinth fistula can lead to hearing deterioration; thus, delicate manipulation is required during surgery for cholesteatomatous fistulae with matrix extension to the perilymphatic space (EPS). However, it remains challenging to identify the EPS preoperatively. This study aimed to evaluate the diagnostic value of computed tomography (CT) for preoperative prediction of the EPS of cholesteatomatous fistulae. Study Design: Retrospective study. Methods: We included serial high-resolution CT images showing a cholesteatomatous bone defect in the lateral semicircular canal (LSC) requiring mastoidectomy. CT and intraoperative findings were analyzed retrospectively. Using axial CT planes, we evaluated the length and angle between the margins of bone defects. Receiver operating characteristic (ROC) curves were constructed to determine the cutoff points. Results: We extracted data from 30 bone defects, of which six (20.0%) showed EPS intraoperatively. Bone defects with EPS (n = 6) had significantly greater length and angle values than those without EPS (n = 24) (P < .001 for both, Wilcoxon rank sum test). For length and angle, the area under the curve was 0.944 (95% confidence interval [CI]: 0.858-1.000) and 0.951 (95% CI: 0.875-1.000), respectively, according to the ROC analysis, and the optimal cutoff values were 3.65 mm and 71.6 , respectively, with 100% sensitivity and 91.67% specificity for both. Conclusions: Results demonstrated that a length >3.65 mm and an angle >71.6 for LSC bone defects on axial CT images are reliable diagnostic markers of EPS. Preoperative high-resolution CT analysis can provide surgeons with a more conscientious preparation for handling deeper labyrinth fistulae.

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One-Stage Complete Resection of Cholesteatoma With Labyrinthine Fistula: Hearing Changes and Clinical Outcomes

Abstract: Although caution is required for total removal of a large fistula, owing to increased risk of postoperative hearing deterioration, 1-stage complete resection of cholesteatoma matrix on labyrinthine fistula could be effective in disease control and long-term hearing preservation.

Cited by 9 publications

References 28 publications

Labyrinthine fistula size as a prognostic factor for postoperative hearing deterioration

Labyrinthine fistula size as a prognostic factor for postoperative hearing deterioration

Presentation, Management, and Hearing Outcomes of Labyrinthine Fistula Secondary to Cholesteatoma: A Systematic Review and Meta-analysis

Imaging Analysis for Cholesteatoma Extension to the Perilymphatic Space in Labyrinth Fistulae

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