Abstract
IntroductionDuring surgery in patients with labyrinthine fistula the mandatory complete removal of the cholesteatoma while preserving inner ear and vestibular function is a challenge. Options so far have been either the complete removal of the cholesteatoma or leaving the matrix on the fistula. We evaluated an alternative “under water” surgical technique for complete cholesteatoma resection, in terms of preservation of postoperative inner ear and vestibular function.MethodsFrom 2013 to 2019, 20 patients with labyrinthine fistula due to cholesteatoma were operated. We used the canal wall down approach and removal of matrix on the fistula was done as the last step during surgery using the “under water technique”. The pre and postoperative hearing tests and the vestibular function were retrospectively examined.ResultsThere was no significant difference between pre and post-operative bone conduction thresholds; 20% experienced an improvement of more than 10 dB, with none experiencing a postoperative worsening of sensorineural hearing loss. Among seven patients who presented with vertigo, two had transient vertigo postoperatively but eventually recovered.ConclusionOur data show that the “under water technique” for cholesteatoma removal at the labyrinthine fistula is a viable option in the preservation of inner ear function and facilitating complete cholesteatoma removal.
Highlights
During surgery in patients with labyrinthine fistula the mandatory complete removal of the cholesteatoma while preserving inner ear and vestibular function is a challenge
Cholesteatoma of the middle ear is a progressive, benign epithelial lesion, characterized by an expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid [1]
In these seven patients the fistula was diagnosed with a pre-operative high-resolution temporal bone Computed Tomography (CT) with two patients having a positive fistula test
Summary
Cholesteatoma of the middle ear is a progressive, benign epithelial lesion, characterized by an expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid [1]. Dissection and removal of matrix including exposure and closure of the bony defect under constant saline water irrigation has been suggested as a possible method wherein complete disease clearance can be achieved with much lesser risk of sensory hearing loss. This method of surgery named the “under water technique” was first described in 2014 and is yet to be studied in bigger cohorts [11]. We hypothesized that applying this technique facilitates complete cholesteatoma removal, while preserving the labyrinth function
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