Managing cholesteatomas with labyrinthine fistula

Area of Science:

• Otolaryngology
• Neurosurgery
• Medical Imaging

Background:

• Cholesteatomas can involve the labyrinthine fistula (LF), posing surgical challenges.
• Accurate diagnosis and management are crucial for preserving hearing and preventing complications.

Purpose of the Study:

• To evaluate the management strategies for cholesteatomas with labyrinthine fistulae (LF).
• To assess the clinical characteristics and postoperative hearing outcomes in patients with LF.

Main Methods:

• Retrospective study of patients undergoing mastoidectomy for cholesteatoma from 2011-2018.
• Analysis of preoperative HRCT, intraoperative findings, and pre/postoperative hearing levels.
• Comparison of outcomes between LF and non-LF groups, and between matrix removal and preservation groups.

Main Results:

• 15.6% of cholesteatomas had LF; HRCT showed high sensitivity and specificity for LF detection.
• LF group had significantly higher rates of stapes, tegmen tympani, and semicircular canal dehiscence.
• Complete matrix removal resulted in unchanged hearing in 77.9% of cases, while matrix preservation led to hearing deterioration.

Conclusions:

• Hearing preservation in LF is achievable with meticulous matrix removal.
• Matrix preservation, even for large LFs, did not yield favorable postoperative hearing results in this cohort.
• Longer follow-up may reveal poorer hearing outcomes with matrix preservation strategies.