Managing cholesteatomas with labyrinthine fistula

A retrospective study (2011 to 2018) was conducted to evaluate the management of cholesteatomas with labyrinthine fistulae (LFs), clinical characteristics and postoperative hearing outcomes in a hospital.

Demographic data of patients with primary middle ear mastoidectomies for cholesteatoma were extracted. Preoperative high-resolution computed tomography (HRCT) temporal bone and intraoperative findings, and hearing levels preoperatively and postoperatively were evaluated.

Of the middle ear cholesteatomas, 15.6% ( n = 14) of ears were complicated by LF. HRCT scans showed 92.9% sensitivity and 94.7% specificity in the identification of LFs. Intraoperative findings of LFs include stapes erosion (78.6%), malleus erosion (78.6%), incus erosion (92.9%), dehiscence of tegmen tympani (28.6%) and tympanic facial canal (64.3%). Compared to the non-LF group, the LF group showed significantly higher incidence of stapes erosion ( P < 0.001), tegmen tympani dehiscence ( P = 0.016) and semicircular canal dehiscence ( P < 0.001). Matrix was removed completely in 85.7% ( n = 12) and was left behind in 14.3% ( n = 2) of ears. Also, 21.5% ( n = 3) had preoperative dead ears. Postoperative hearing results had a mean follow-up time of 2.1 (standard deviation 1.5, range 0.14-4.84) years. In the matrix removal group ( n = 9), 77.9% had unchanged hearing levels, 11.1% showed improvement and 11.1% showed decrease in hearing levels. The matrix preservation group ( n = 2) had deteriorated hearing levels.

Preservation of hearing in LFs is possible with cautious matrix removal. Despite matrix preservation to preserve hearing in large LFs, our patients' hearing deteriorated postoperatively. Longer follow-up of hearing with matrix preservation may show poorer hearing outcomes.