Management of the Labyrinthine Fistula in Cholesteatoma Surgery

Sanna, Maria Paola; Zini, C; Bacciu, S; Scandellari, R; Delogu, P; Jemmi, G

doi:10.1159/000275704

Cited by 35 publications

(43 citation statements)

References 10 publications

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“…Fistulas occur almost exclusively in the setting of a cholesteatoma. 2 ' 47 In the current study, a cholesteatoma was found in 33 of the 34 cases (97%). The lateral SCC was the most common site involved in this study (94%) and in previously reported cases.…”

Section: Discussionsupporting

confidence: 44%

Clinical Presentation and Management of Labyrinthine Fistula Caused by Chronic Otitis Media

Busaba¹

1999

Ann Otol Rhinol Laryngol

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To describe the clinical presentation and surgical management of patients with chronic otitis media complicated by labyrinthine fistula and to determine clinical indicators that predict postoperative hearing outcome, I performed a retrospective analysis at an academic tertiary care center. Thirty-four patients with labyrinthine fistula as a complication of chronic otitis media, documented at mastoidectomy, underwent postoperative audiometry. The median age was 50 years, and the duration of otologic symptoms ranged from 2 months to more than 40 years. On presentation, 3 patients had anacusis in the affected ear, while in the others, the pure tone average for bone conduction at the 0.5-, 1-, 2-, and 4-kHz frequencies was 34 dB hearing level. Nineteen patients (56%) complained of dizziness on presentation. The fistula test was positive in 14 of 28 patients (50%). The fistula was detected radiologically in 10 of 24 patients (42%). Cholesteatoma was present in 33 of 34 patients (97%). The lateral semicircular canal was the most common site of labyrinthine fistula. The cholesteatoma matrix was completely removed in 29 of 33 cases and exteriorized in the remaining 4. Of the 31 patients with measurable hearing preoperatively, anacusis occurred in 8 (26%). In 6 of these, the preoperative pure tone average for bone conduction was greater than 50 dB hearing level, and cholesteatoma matrix and granulation tissue invading the membranous labyrinth were found at surgery. I concluded that in chronic otitis media, labyrinthine fistulas occurred almost exclusively in the presence of a cholesteatoma. Postoperative hearing outcome correlated with the size of the fistula and the presence of granulation tissue invading the labyrinth. which could be predicted by the preoperative audiometry.

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Section: Discussionsupporting

confidence: 44%

Clinical Presentation and Management of Labyrinthine Fistula Caused by Chronic Otitis Media

Busaba¹

1999

Ann Otol Rhinol Laryngol

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“…Some authors classify the Wstulas according to their size in mm [23,26]. Others believe that depth of invasion better correlates with prognosis than size [27].…”

Section: Classiwcation Of Labyrinthine Wstulamentioning

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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“…Fistula of the labyrinth complicating chronic suppurative otitis media (CSOM) has been reported in 5-13% of patients who underwent mastoidectomy for cholestatoma (1)(2)(3)(4)(5)(6)(7). Bone erosion and subsequent stula formation most frequently occurs in the horizontal semicircular canal in adults with a long history of CSOM (2,8,9), but stulas have also been reported in younger patients with a shorter duration of CSOM (2).…”

Section: Introductionmentioning

confidence: 99%

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

Kvestad

Kværner²,

Mair³

2001

Acta Oto-Laryngologica

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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.

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Management of the Labyrinthine Fistula in Cholesteatoma Surgery

Cited by 35 publications

References 10 publications

Clinical Presentation and Management of Labyrinthine Fistula Caused by Chronic Otitis Media

Clinical Presentation and Management of Labyrinthine Fistula Caused by Chronic Otitis Media

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

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

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