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. 2017 Oct;274(10):3605-3612.
doi: 10.1007/s00405-017-4697-2. Epub 2017 Aug 10.

Management of labyrinthine fistula: hearing preservation versus prevention of residual disease

S Geerse  1 , M J F de Wolf  2 , F A Ebbens  2 , E van Spronsen  2
Affiliations

Management of labyrinthine fistula: hearing preservation versus prevention of residual disease

S Geerse et al. Eur Arch Otorhinolaryngol. 2017 Oct.

Abstract

The objective of the study was to evaluate postoperative hearing and disease control after cholesteatoma surgery for labyrinthine fistulas. In a retrospective cohort study, we evaluated a consecutive cohort comprising 44 patients (45 ears) with labyrinthine fistulas associated with chronic otitis media with cholesteatoma who underwent surgery between 2002 and 2015. We looked at patient characteristics, pre- and postoperative bone conduction thresholds (BCT), operative approach and findings, extent of disease and the occurrence of residual disease. All deaf ears (24%) presented preoperatively with a large fistula. Opening the membranous labyrinth resulted in significantly worse postoperative BCT (p = 0.01). Neither the present study nor a literature search revealed a significant positive effect of corticosteroids on postoperative hearing preservation. Large fistulas were correlated with poorer preoperative BCTs, but not with poorer postoperative BCTs. Opening the membranous labyrinth during surgery is correlated with poorer postoperative BCTs and can be seen as a predictive parameter. The use of corticosteroids in the perioperative management of labyrinthine fistula was not found to result in any improvement in postoperative BCTs.

Keywords: Bone conduction threshold; Cholesteatoma; Computed tomography; Ear surgery; Labyrinthine fistula.

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Conflict of interest statement

Funding

None.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Since this is a retrospective study no informed consent was obtained.

Figures

Fig. 1
Fig. 1
Subgroups in the study cohort. A Total cohort, B evaluation of postoperative hearing with complete hearing tests, C evaluation of postoperative hearing with complete hearing tests and only fistula in LSC, D deaf ears, E ears without complete hearing tests
Fig. 2
Fig. 2
Pre- (x-axis) and postoperative (y-axis) hearing (PTA in dB) in group B as related to different variables. a Primary or revision surgery. b Type of surgery (CAT combined approach tympanoplasty, PHORC partial hydroxy-apatite obliteration and reconstruction of the canal wall, STP subtotal petrosectomy). c Membranous labyrinth opened or not. d Number of damaged labyrinthine structures. e Specific labyrinthine structures (LSC lateral semicircular canal, SSC superior semicircular canal). f Fistula size graded with the Sanna classification1
Fig. 3
Fig. 3
Comparison of our data with the data of Jang et al.1 for postoperative hearing (PTA in dB) in relation to fistula size (mm)
See this image and copyright information in PMC

References

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