Management of the open labyrinth

Abstract

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.

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].…”

Preservation of Post Operative Bone Conduction Hearing after Labyrinthine Fistula Repair in Chronic Otitis Media with Cholesteatoma: A Review of 23 Cases

“…On the other hand, Palva et al and Quaranta et al [10,12] found that the prognosis of labyrinthine fistula was correlated with invasion depth rather than fistula size. Dornhoffer et al [6] classified labyrinthine fistulas by cholesteatoma penetration depth, and reported that range and depth of labyrinth penetration were associated with the preservation of postoperative bone conduction hearing. Subsequently, several researchers used this taxonomy to examine treatment results.…”

“…Dornhoffer et al [6] have reported that a transvenous corticosteroid injection just before removal of the cholesteatoma matrix is effective at conserving hearing.…”

H�rergebnisse nach Verschluss von Labyrinthfisteln bei Patienten mit Cholesteatomen

“…Neben der chirurgischen Behandlung empfehlen einige Autoren eine intraoperative Behandlung mit Kortison nach einem streng festgelegten Schema und sahen insbesondere bei Fisteln der Grade IIb und III deutlich bessere postoperative Ergebnisse [3,12]. Zur unterschiedlichen Prognose einer Labyrinthfistel bei unterschiedlicher Lokalisation liegen bisher kaum Daten vor.…”

“…al. [12] und Dornhoffer und Milewski [3] die intraoperative Gabe von 500 mg Prednisolon außerdem an weiteren 2 Tagen postoperativ. Darunter kam es insbesondere bei Fisteln vom Grad IIb und III zu einer Verbesserung des Gehörs.…”