Tomasoni Michele, Arcuri Mara, Dohin Isabelle, Zorzi Silvia, Borsetto Daniele, Piazza Cesare, Redaelli de Zinis Luca Oscar, Sorrentino Tommaso, Deganello Alberto
Department of Otolaryngology-Head and Neck Surgery, ASST Spedali Civili, University of Brescia, Brescia, Italy.
Department of ENT Surgery, Cambridge University Hospitals, Cambridge, UK.
Otol Neurotol. 2022 Dec 1;43(10):e1058-e1068. doi: 10.1097/MAO.0000000000003716. Epub 2022 Oct 3.
The current study systematically reviewed the literature to compare auditory outcomes of patients treated for labyrinthine fistula (LF) based on characteristics of disease and surgical management.
PubMed, Scopus, Web of Science.
Original series (at least five cases) published from 2000 reporting management and hearing results of LF secondary to cholesteatoma were included. Proportion and odds-ratio (OR) meta-analyses were conducted through inverse variance random-effects models based on logit transformation.
The prevalence of LF is estimated to be 7% (95% confidence interval [CI], 5-9%). Fistulae involving the lateral semicircular canal (90%; 95% CI, 87-93%) and larger than 2 mm (53%; 95% CI, 43-64%) were common, whereas membranous involvement was less frequent (20%; 95% CI, 12-30%). Complete removal of the cholesteatoma matrix overlying the LF was mostly applied. Bone conduction (BC) preservation was frequently achieved (81%; 95% CI, 76-85%); new-onset postoperative anacusis was rarely reported (5%; 95% CI, 4-8%). A higher chance of BC preservation was associated with sparing the perilymphatic space (OR, 4.67; 95% CI, 1.26-17.37) or membranous labyrinth (OR, 4.56; 95% CI, 2.33-8.93), exclusive lateral semicircular canal involvement (OR, 3.52; 95% CI, 1.32-9.38), smaller size (<2 mm; OR, 3.03; 95% CI, 1.24-7.40), and intravenous steroid infusion (OR, 7.87; 95% CI, 2.34-26.42).
LF occurs in a significant proportion of patients with cholesteatoma. In the past two decades, complete removal of the cholesteatoma matrix followed by immediate sealing has been favored, supported by the high proportion of BC preservation. Hearing preservation depends primarily on characteristics of the LF, and specific surgical strategies should be pursued. Intraoperative and postoperative intravenous steroid infusion is recommended.
本研究系统回顾文献，以根据疾病特征和手术管理方式比较接受迷路瘘管（LF）治疗患者的听觉预后。
PubMed、Scopus、科学网。
纳入2000年以来发表的报告胆脂瘤继发LF治疗及听力结果的原始系列研究（至少5例）。基于对数变换，通过逆方差随机效应模型进行比例和比值比（OR）荟萃分析。
LF的患病率估计为7%（95%置信区间[CI]，5-9%）。累及外侧半规管的瘘管（90%；95%CI，87-93%）及直径大于2mm的瘘管（53%；95%CI，43-64%）较为常见，而膜性结构受累较少见（20%；95%CI，12-30%）。大多采用完全清除覆盖LF的胆脂瘤基质。骨传导（BC）保留情况较为常见（81%；95%CI，76-85%）；术后新发全聋罕见（5%；95%CI，4-8%）。BC保留几率较高与保留外淋巴间隙（OR，4.67；95%CI，1.26-17.37）或膜迷路（OR，4.56；95%CI，2.33-8.93）、仅累及外侧半规管（OR，3.52；95%CI，1.32-9.38）、较小尺寸（<2mm；OR，3.03；95%CI，1.24-7.40）以及静脉注射类固醇（OR，7.87；95%CI，2.34-26.42）相关。
LF在相当比例的胆脂瘤患者中出现。在过去二十年中，完全清除胆脂瘤基质后立即封闭受到青睐，这得到了高比例BC保留的支持。听力保留主要取决于LF的特征，应采取特定的手术策略。建议术中及术后静脉注射类固醇。
