[Diagnosis and surgical management of labyrinthine fistula caused by cholesteatoma].

OBJECTIVE

To describe the clinical presentation and surgical management of patients with labyrinthine fistula caused by cholesteatoma.

METHOD

Retrospective study of the clinical presentation, surgical technique and hearing outcomes based on 350 cases of chronic otitis media with cholesteatoma was carried out. Twenty three patients (6.6%) with labyrinthine fistula were found, in 9 ears (39.1%) the preoperative pure tone average for bone conduction was greater than normal, including 2 cases of analysis. Subjective vertigo or dizziness occurred in 11 patients (47.8%), the fistula test was positive in 5 patients (21.7%). Preoperative high resolution computed tomography (HRCT) scans were performed on all patients and 13 patients (57%) were detected to be with labyrinthine fistula in imaging. During the operation we found the lateral semicircular canal was the most commonly affected site (20/23), at the same time dehiscence of the facial canal was observed in 8 patients.

RESULT

The patients were followed-up for an average time of 2 years, dizziness disappeared completely in 22 cases and there were no significant changes in their bone conduction thresholds.

CONCLUSION

Labyrinthine fistulae are usually caused by cholesteatoma. There are no reliable methods at present for preoperative diagnosis HRCT is useful but its limitations should also be recognized. The verification of a labyrinthine fistula can be definitively established only at the time of surgery. Completely remove the cholesteatoma matrix can be the treatment of choice in these cases.