Abstract
PurposeThe 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.MethodsStudy group included 465 patients. Cases with LFs discovered or confirmed during surgical procedure were thoroughly analyzed.ResultsLFs 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.
Highlights
Labyrinthine fistula (LF) is the most common intratemporal complication of chronic otitis media with cholesteatoma
The first point of controversy still regards the technique (CWU or canal wall down (CWD)) that should be performed in case of cholesteatomatous LF
Most authors underline that the decision on preservation of posterior canal wall should not be determined by the presence of LF but should depend on many factors including hearing status of the operated and contralateral ear, location and extension of the cholesteatoma, coexistence of other complications, patient’s age and general condition [3, 5, 12]
Summary
Labyrinthine fistula (LF) is the most common intratemporal complication of chronic otitis media with cholesteatoma.
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