Labyrinthine fistulae as a complication of chronic suppurative otitis media

Abstract

Objectives: The aim of this study is to present observation concerning clinical features, diagnosis and menagement of labyrinthine fistulae secondary to chronic suppurative otitis media. Methods: The authors studied 160 surgically treated patients with labyrinthine fistulae due to chronic otitis media with cholesteatoma. The material does not include erosion or incomplete fistula presenting itself as a bluish line on the labyrinth, but with a layer of bone is still intact. Results: In 136 (85.5%) of operated ears, the labyrinthine fistulae were found at the first surgery and in 24 (14.5%) at a reoperation. In a number of patients other complications were associated with the fistula such as peripheral facial paralysis, meningitis, and brain abscess. Total deafness and sensorineural hearing loss are commonly occurred with labyrinthine fistulae (63.1%). Preoperative fistula test was negative in 42% patients. The multiple fistulae were found in 14% patients. The fistulae were most commonly localized on the lateral semicircular canal (l 7%) and much less frequently involved only the oval window area (7%) and promontory (4%). The closed technique was used, while the open technique was adopted only when the ear was deaf preoperatively, in cases of multiple fistulae and associated intracranial complications. Conclusion: The cholesteatoma matrix should not be removed from fistulae of the oval window area, the promontory, multiple fistulae and large fistulae of the lateral semicircular canal if the matrix has already penetrated into the labyrinth. After removal of the matrix over fistulae of the lateral semicircular canal, a temporalis fascia graft should be used for cover.