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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Thank you for your interest in our study and also for presenting your concerns. Our previous article [1] describing the prognostic indicators of hearing after complete resection of cholesteatoma causing a labyrinthine fistula reported that the preoperative high-resolution thin sliced 0.55 mm CT-scan is a very precise tool for diagnosing labyrinthine fistulas with a sensitivity and specificity of 100%.It is well known that the absence of fluid in the semicircular canal (no signal on T2 MRI) or the presence of fluid in the semicircular canal (high-signal on T2 MRI) can help us to identify the presence or not of fibrous tissue in the labyrinth. However, nowadays it is impossible for the MRI to identify the disruption of the membranous labyrinth by the cholesteatoma. The membranous labyrinth could be invaded by the cholesteatoma with no fibrous development in the labyrinth; in these cases of membranous fistula, the risk of postoperative sensorineural hearing loss is higher than the cases of bone fistulas. Once again, in the cases of cholesteatoma, the MRI cannot differentiate the membranous fistula from a bone fistula in the absence of labyrinthine fibrosis. Therefore, it cannot predict the postoperative hearing outcome after a complete removal of the matrix.In our study, we reported the importance of the highresolution thin sliced CT-scan to identify labyrinthine fistula reaching 3.55 mm to suspect a membranous fistula with a sensitivity of 66% and a specificity of 71%. Thus, the preoperative counseling of the patient is more precise and more realistic especially about the postoperative sensorineural hearing loss.

Background: Goode T-Tubes (Medtronic Xomed, Inc) have a bad reputation because of their residual tympanic perforation rate. However, these long-term tubes are mostly used in patients with chronic middle ear problems. On the other hand, "safer," shortterm tubes mav need to be reinserted in up to 20% of children.Objective: To demonstrate that modified Goode T-Tubes inserted at the first myringotomy in normal children leave a perforation rate comparable to the rate reported in the literature for short-term tubes and may be extracted safely in the outpatient clinic when eustachian tube function is thought to be adequate.Method: This prospective study followed 58 children (100 ears) who had their modified Goode T-Tubes electively removed in the clinic, from October 2003 to November 2004, Results: We found only one persistent perforation at the third follow-up (mean time 5.2 months). The tubes had been in place for an average of 2.9 years. The perforation healing rate was inversely related to intubation duration. Adenotonsillectomy seemed to favourably influence the speed of healing. The perforations healed faster when tubes were inserted for chronic middle ear effusion compared with recurrent acute otitis media. Age, gender, and the site of intubation were not related to persistent perforation. All of the tubes spontaneously extruded (13) healed without perforation.Conclusion: Modified Goode T-Tubes inserted at the first myringotomy and electively extracted allow for a longer middle ear ventilation period and have a perforation rate comparable to that of short-term tubes.