Surgical treatment of labyrinthine fistula in patients with cholesteatoma

Ueda, Yoshihisa; Kurita, Tomoyuki; Matsuda, Youichi; Ito, Shinsuke; Nakashima, Tsutomu

doi:10.1017/s0022215109005118

Cited by 23 publications

(34 citation statements)

References 11 publications

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“…In Ueda's [24] group of 27 labyrinthine fistulas 26% showed improved hearing, 63% showed no change and 11% showed a deterioration after a canal wall down with total matrix removal as a one-stage procedure. One might wonder whether the results in this study might have improved by additional steroid treatment; since the authors did not state whether they used any cortisone or antibiotics pre-operatively, we assumed that here reported results were obtained without these agents.…”

Section: Discussionmentioning

confidence: 96%

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: 96%

Preserving bone conduction in patients with labyrinthine fistula

Gocea

Martinez-Vidal

Panuschka

et al. 2011

Eur Arch Otorhinolaryngol

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“…Hearing loss (90%), otorrhea (65%) and dizziness (50%) are the most frequent presenting symptoms [7]. Although history of disease and clinical examination are essential in diagnosing a labyrinthine Wstula, classical signs and symptoms associated with Wstulas are neither sensitive nor speciWc for the disease [8][9][10][11]. High-resolution computerized tomography (CT) scan included in the preoperative assessment of cholesteatoma allows a high rate of suspicion for labyrinthine Wstulas [1,7,9,12].…”

Section: Introductionmentioning

confidence: 99%

“…Two general approaches can be found in the literature: complete cholesteatoma removal with repair of the bony defect, and partial resection with residual matrix left over the Wstula site with exteriorization of the mastoid cavity. Supporters of the former method believe in the beneWts of complete removal of the source of inXammation and bone erosion [1,4,[8][9][10][13][14][15][16][17][18][19][20][21]. On the other hand, advocates of the second technique suggest these gains must be counterbalanced with a higher risk of sensorineural hearing loss [22,23].…”

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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“…Over the years, SSC fistula complicating a chronic suppurative otitis media has been reported in a constant range of 3-12.7% in patients with cholesteatoma [1][2][3][4][5][6][7][8][9]. Of these, a second fistula on another SSC was present in 7-11% of cases [1,2].…”

Section: Discussionmentioning

confidence: 99%

“…Of these, a second fistula on another SSC was present in 7-11% of cases [1,2]. Bony erosion and subsequent fistulas formation occurs most frequently in the lateral semicircular canal counting for nearly 90% of the cases of labyrinthine fistulas [1,3,6,8]. The prevalence of superior and posterior semicircular canal fistulas reported in the literature is respectively 6% and 2% [1,3,6,9].…”

Section: Discussionmentioning

confidence: 99%