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

Abstract

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.

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

“…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).…”

“…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%).…”

“…Auditory Outcomes Most studies reported auditory outcomes providing the mean BC either as the result of the thresholds at frequencies 0.5, 1, 2, and 3 kHz (7,8,26,33,37,42,43) as recommended, or as the results of the thresholds at frequencies 0.5, 1, 2, and 4 kHz (10,11,23,24,28,29,31,35,36,38,44,46,47) or 1, 2, and 4 kHz (34,41), which are considered comparable to the standard set by the Committee on Hearing and Equilibrium guidelines (48,49).…”

Surgery for Cholesteatomatous Labyrinthine Fistula

“…A total of 28 studies reported hearing data. 2,5-31 One of these articles was excluded because only 1 patient was reported in the study. 31 Of the remaining 27 studies, no significant difference was noted between the matrix removal versus exteriorization (Table 3).…”

“…All studies that directly compared the 2 were analyzed separately using odds ratios—greater than 1 favored staged matrix removal, and less than 1 favored an unstaged removal. 2,5-7,9-28…”