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

Portier, F.; Lescanne, E.; Racy, E.; Nowak, C.; Lamblin, Benoit; Bobin, S.

doi:10.2310/7070.2005.00001

Cited by 22 publications

(7 citation statements)

References 5 publications

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“…The oval window, or missing footplate, was involved in eight cases [25%], an incidence much higher than that reported elsewhere [5,15,16,21]. Seven of these fistulas were discovered during revision tympano-mastoidectomies for cholesteatoma which had been operated on many years previously; only one case was discovered during a primary tympano-mastoidectomy for cholesteatoma at the level of fissula antefenestram.…”

Section: Discussionmentioning

confidence: 85%

“…Prognosis is worse for cochlear or vestibular fistulas than for those located in the semicircular canals; and in the latter, the risk of hearing loss appears to be greater if the fistula is situated in the superior or posterior semicircular canal rather than in the lateral canal [16].…”

Section: Discussionmentioning

confidence: 93%

“…Their management is still a controversial issue and different studies have provided evidence in favor of both complete matrix removal and matrix in situ techniques [16,17]. In any case, all the recommendations aim to avoid sensorineural hearing loss in order to preserve hearing.…”

Section: Discussionmentioning

confidence: 99%

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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: 85%

Section: Discussionmentioning

confidence: 93%

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Preserving bone conduction in patients with labyrinthine fistula

Gocea

Martinez-Vidal

Panuschka

et al. 2011

Eur Arch Otorhinolaryngol

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“…Usually, the defect is created while the perimatrix, which has already eroded the bony wall of the canal, is lifted from the delicate membranous labyrinth. If a patient with cholesteatoma shows clinical symptoms/signs of a labyrinthine fistula before surgery (summarized by [2]), a preoperative HRCT may help to detect and localize the bony defect [67], [68]. The prevalence of cholesteatoma-related fistulae has been reported with 5.8% [68], 7% [63] and 7.5% [69] in the literature.…”

Section: General Intraoperative Aspects Of Ear Surgerymentioning

confidence: 99%

“…Preservation of preoperative hearing thresholds was reported in 80% of 22 patients and 70% of 27 patients following complete removal of cholesteatoma perimatrix from a labyrinthine fistula [68], [69], while another study observed postoperative hearing deterioration in one of 16 patients [73]. Following removal of the cholesteatoma from the fistula, the resulting bony defect is sealed with bone dust and fibrin glue/blood together with an i.v.…”

Section: General Intraoperative Aspects Of Ear Surgerymentioning

confidence: 99%

Surgery of the ear and the lateral skull base: pitfalls and complications

Schick

Dlugaiczyk

2013

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 12:Doc05; ISSN 1865-1011

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

Abstract: Surgery with removal of the cholesteatoma matrix and sealing of the fistula with temporalis fascia is a safe procedure that can help preserve cochlear function. The choice of a canal down procedure would be influenced by cholesteatoma characteristics rather than by the finding of an LF.

Cited by 22 publications

References 5 publications

Preserving bone conduction in patients with labyrinthine fistula

Preserving bone conduction in patients with labyrinthine fistula

Surgery of the ear and the lateral skull base: pitfalls and complications

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

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