Labyrinthine fistulas occur in approximately 5% of cholesteatoma cases, but the management of this difficult problem remains controversial. This study assessed the preoperative presentation and outcome in 37 patients operated on for cholestatoma complicated by labyrinthine fistula. Therapy involved removing the matrix from each fistula and reconstructing the bony wall of the labyrinth with bone dust, fibrin glue, and perichondrium. Corticosteroids were added to the management protocol in more recent cases. A fistula classification scheme was introduced to standardize the reporting of the extent of labyrinthine involvement and results of treatment. The most common preoperative symptoms, sensorineural hearing loss and vertigo, were notably lacking in more than 30% of patients. The fistula test was positive in only 32% of cases. Corticosteroids were seen to have a beneficial impact on postoperative outcome in those cases involving injury to the membranous labyrinth or removal of perilymph.

In ears with advanced pathology, the functional and anatomical results of surgery are compromised by such factors as total perforation, tympanosclerosis, atelectasis, suppuration, or previous surgery. Perichondrium cartilage composite grafts (PCCGs) were used for membrane grafting in 550 such cases over a period of 5 years. In all, 197 tympanoplastic procedures of type I (25% with previous surgery) and 353 of type III (47% with previous surgery) were carried out. The graft was obtained from the tragus and/or the concha. Two slightly different surgical techniques of grafting were used. Closure of the eardrum perforation was successful in 92% of the procedures. An air-bone gap of less than or equal to 30 dB was obtained in 92.4% of tympanoplasty type I procedures and in 79% of tympanoplasty type III procedures. The conclusion drawn from the results is that PCCG is a reliable graft in cases of advanced destruction of the middle ear.

Objectives-To evaluate an interdisciplinary concept (neurosurgery/ear, nose, and throat (ENT)) of treating acoustic neuromas with extrameatal extension via the retromastoidal approach. To analyse whether monitoring both facial nerve EMG and BAEP improved the functional outcome in acoustic neuroma surgery. Methods-In a series of 508 patients consecutively operated on over a period of 7 years, functional outcome of the facial nerve was evaluated according to the House/Brackmann scale and hearing preservation was classified using the Gardner/Robertson system.

The predictive power of the amplitudes and latencies of electrically evoked muscle responses could be improved by calculating proximal/distal ratios. The proximal/distal amplitude ratio proved to be the most powerful parameter for intraoperative assessment of postoperative FNF.

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