Labyrinthine Fistula Detection: The Predictive Value of Vestibular Symptoms and Computerized Tomography

Abstract

A retrospective case record study of 20 patients in Oslo operated on for chronic otitis media with labyrinthine fistula between 1986 and 1999 was performed in order to estimate the incidence of, and identify predictors for, labyrinthine fistulas. The incidence of fistula was 0.3 per 100 000, with a median age at diagnosis of 37 years. The median duration of chronic otitis media prior to labyrinthine fistula detection was significantly correlated with age at surgery. Subjective hearing loss (90%), otorrhoea (65%) and dizziness (50%) were presenting symptoms. Modified canal-wall-down mastoidectomy was performed in all patients. Preoperative hearing levels could not predict postoperative hearing outcome. Positive signs of fistula were found in only 4 patients (20%). Correspondingly, computerized tomography (CT) diagnosed the fistula in 11 patients (55%). The seven patients presenting without dizziness and with a negative CT scan and fistula test were characterized by lower age, absence of previous middle ear surgery, lower preoperative pure-tone thresholds for bone conduction and better hearing outcome after surgery. In conclusion, the identification of a younger group of patients presenting with fewer symptoms indicates that fistulas should be suspected in all patients undergoing surgery for chronic middle ear and mastoid disease.

Canal wall window mastoidectomy for extensive labyrinthine cholesteatoma: Total dissection and hearing preservation

“…At 26 months follow-up, the patient had an average of 10 dB of bone conduction improvement at 0.5, 1, 2 and 4 kHz. Unlike other studies, our patient was much younger than what has been previously reported where the mean age vary from 37 to 56 years [6][7][8][9]. Cholesteatomas in children have a more aggressive growth pattern relative to adults [12][13][14].…”

“…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].…”

“…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].…”

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

“…Its incidence varies between 4 and 12%, with a predilection for the horizontal semicircular canal (SCC) representing 66-90% of Wstulas [1][2][3][4][5][6]. 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].…”

“…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].…”