Labyrinthine fistula from cholesteatoma: surgical management

Labyrinthine fistula is a complication of chronic otitis media with cholesteatoma which can result in progressive sensory hearing loss or permanent loss of inner ear function. Total surgical removal of cholesteatoma and use of the intact canal wall tympanoplasty and mastoidectomy can result in preservation or improvement of hearing and elimination of vertigo. Long-term results in a series of 63 cases are reported. The important features of surgical technique involve use of high magnification with the operating microscope, a high-speed drill, suction irrigation and thorough knowledge of temporal bone anatomy. In addition, the surgeon must avoid tearing or perforation of the squamous epithelium basement membrane during dissection. In some cases, sensory hearing returns to normal following surgery, making a successful second-stage reconstruction for hearing possible.