Preserving bone conduction in patients with labyrinthine fistula

Abstract

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.

Management of labyrinthine fistula: hearing preservation versus prevention of residual disease

“…Labyrinthine fistula is regarded as the most frequent complication of otitis media with cholesteatoma [ 6 , 11 ]. The management of a labyrinth fistula is challenging in itself and there are several other variables that add to that difficulty.…”

“…As the literature assumes that intravenous corticosteroids during the peeling of the cholesteatoma matrix of the labyrinth may be beneficial [ 2 , 10 , 11 , 18 ], we looked at this method in the light of our data. No statistical difference was found in literature search or in our direct comparison to the data of Jang et al [ 10 ].…”

“…We defined significant sensorineural hearing loss as >10 dB loss at two or more frequencies. Hearing improvement was defined as 10 dB or more improvement at two or more frequencies [ 10 , 11 ]. The following parameters were evaluated to determine the possible effect on pre- or postoperative hearing: fistula size, primary or revision surgery, surgical technique, opening of the membranous labyrinth intraoperatively, extent of affected inner ear structures and the specific structure involved.…”

“…Positive effects on postoperative hearing have been described when intravenous corticosteroids are applied during surgery [ 3 , 10 , 11 ]. Obliteration of the mastoid is thought to reduce postoperative dizziness [ 10 ].…”

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

“…Recent studies have shown that complete removal of the cholesteatoma matrix and fistula closure effectively control disease and preserve hearing [13,15] . According to these studies, if the matrix is left over the fistula site, the risk of labyrinthitis increases and sensorineural hearing loss or deafness may occur.…”