“Sandwich technique” enables preservation of hearing and antivertiginous effect in cholesteatomatous labyrinthine fistula

Abstract

Purpose The aim of the study was to assess hearing, surgical and clinical results of the treatment in patients with cholesteatomatous labyrinthine fistula (LF) focusing on the different techniques and materials used in the management. Methods Study group included 465 patients. Cases with LFs discovered or confirmed during surgical procedure were thoroughly analyzed. Results LFs were noted in 11.4% of all cases. Thirty-eight patients, with all follow-up data available, were included into the further analysis. Most LFs were located in the lateral semicircular canal (87%). LFs were assessed as small in 2 cases, as medium in 24 patients while 12 were described as large. Based on Dornhoffer and Milewski classification, 50% of LFs were classified as IIa, 24% as IIb, 6 LFs were very deep (type III), while 4—superficial (type I). The size and type of LF did not influence postsurgical complaints (p = 0.1070, p = 0.3187, respectively). Vertigo was less frequent in LFs treated by “sandwich technique”, especially those with opened endosteum. In 30 (79%) patients, hearing improved or did not change after surgery. Hearing outcomes were significantly better in the ears operated by means of CWU technique (p = 0.0339), in LFs with intact membranous labyrinth (p = 0.0139) and when “sandwich technique” was performed (p = 0.0159). Postsurgical bone conduction thresholds levels were significantly better in LFs covered by “sandwich method” (p = 0.0440). Conclusion “Sandwich technique” (temporal fascia–bone pate–temporal fascia) enables preservation of hearing as well as antivertiginous effect in patients with cholesteatomatous labyrinthine fistula.

Presentation, Management, and Hearing Outcomes of Labyrinthine Fistula Secondary to Cholesteatoma: A Systematic Review and Meta-analysis

“…New-onset postoperative anacusis was a rare occurrence (pooled proportion, 5%; 95% CI, 4–8%; I 2 = 0%; Supplementary Fig. 18, http://links.lww.com/MAO/B515); when observed (7,11,23,25,29,31,38,41), it did not exceed 10% of cases (Table 1).…”

“…Among 947 patients affected by LF, a slight male prevalence was observed (pooled proportion, 55%; 95% CI, 51–59%; I 2 = 41%). Mean and median ages at diagnosis were quite heterogeneous, reported to be in the fourth decade by 7 studies (17,24,29,32,39,46,47), in the fifth by 9 (7,9,16,23,25,28,38,41,45), and in the sixth by 10 (10,11,26,27,31,33–35,37,43).…”

“…Most studies were retrospective unicentric series. A prospective or combined retrospective and prospective data collection was conducted in only three studies (8.8%) (7,16,30), whereas (5.9%) multicenter experience was reported in two studies (10,34).…”

“…Clinical Evaluation The number of operations for cholesteatoma during the period of observation was reported by most studies (2,7,9,10,17,18,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)38,(40)(41)(42)(45)(46)(47). Overall, on 13,554 operations for cholesteatoma, the pooled prevalence of LF was 7% (95% CI, 5-7%; I = 89%).…”

“…Eleven studies reported on the use of intraoperative steroids (7,(9)(10)(11)16,23,28,29,36,45,47), but only three described auditory outcomes with complete matrix removal comparing groups of patients receiving or not i.v. steroids (7,10,11). The steroid infusion protocols of Albu et al (10) and Gocea et al (11) were consistent with that proposed by Dornhoffer and Milewski (intraoperative infusion of 500 mg of methylprednisolone 20 min before matrix removal and after surgery for 2 d) (6).…”