Labyrinthine Fistula-Our Experience at a Tertiary Hospital

Area of Science:

• Otolaryngology
• Neurosurgery
• Radiology

Background:

• Labyrinthine fistulae (LF) are abnormal inner ear communications causing perilymph leakage, hearing loss, and vertigo.
• Cholesteatoma is a common cause, frequently involving the lateral semicircular canal due to its proximity to the middle ear.
• Accurate anatomical localization of LF is crucial for surgical planning and preventing inner ear injury.

Purpose of the Study:

• To determine the anatomical site of labyrinthine fistulae in patients with chronic suppurative otitis media.
• To analyze the correlation between fistula location and clinical manifestations like vertigo and hearing loss.
• To evaluate the utility of HRCT scans in identifying fistula location and extent.

Main Methods:

• Retrospective analysis of 36 patients with chronic suppurative otitis media and labyrinthine fistula confirmed by HRCT.
• Patients underwent tympanomastoid surgery (canal wall down or cortical mastoidectomy).
• Analysis of clinical data (vertigo, nystagmus, hearing loss) and radiological findings of fistula location and length.

Main Results:

• Labyrinthine fistulae were most commonly found in the lateral semicircular canal (17/36 towards the ampullary end).
• Atticoantral disease was the most frequent diagnosis (22/36) associated with labyrinthine fistulae.
• The average fistula length was 4 mm, ranging from 2 mm to 6 mm.

Conclusions:

• Labyrinthine fistulae in chronic suppurative otitis media predominantly affect the lateral semicircular canal, particularly the ampullary end.
• Preoperative HRCT imaging is essential for precise anatomical localization of fistulae, guiding surgical intervention.
• Careful surgical technique, including protecting the endosteal membrane and covering exposed fistulae, is vital to preserve inner ear function.