Int. Adv. Otol. 2009; 6(1); 18-24

Labyrinthine fistula secondary to cholesteatomaous chronic otitis media
Murat Sari, Tekin Baglam, Ozmen Ozturk, Caglar Batman
Marmara University School of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Istanbul, Turkey  msari@marmara.edu.tr

Objective: To analyze clinical presentation, preoperative diagnostic methods, surgical treatment and postoperative outcomes
of labyrinthine fistula (LF) secondary to cholesteatomatous chronic otitis media.

Materials and Methods: Of 582 mastoid surgeries performed, a retrospective review of 33 patients with LF secondary to
cholesteatomatous chronic otitis media was performed.
Setting: Tertiary referral center.

Interventions: Audiologic evaluation with pure tone bone conduction average (PTA-bone) and radiologic imaging studies with
temporal bone computed tomography (CT) scanning were evaluated. Open technique with a removal of the cholesteatoma
matrix and sealing the fistula site with connective tissue was preferred.
Main outcome measures: Auditory results were evaluated as a function of LF size and site.

Results: Incidence of LF was 5.7 % (n:33). Isolated fistula of the lateral semicircular canal was found in 25 patients (75.7%),
and isolated involvement of the oval window was found in one patient (3%). Multiple fistulas were detected in 7 patients
(21.2%). In 31 patients (88.2%), the cholesteatoma was completely removed, and the fistula was sealed; and in 2 patients
(5.8%) the matrix was left intact after exteriorization. One patient (3%) presented with anacusis. Postoperatively, hearing
remained in the same range in 24 patients (72.7%). In 8 patients (24.2%) a reduction of PTA-bone was observed, and 2 patients
(6%) presented with postoperative anacusis. Vertigo improved or disappeared in 14 (42.4%) cases, and remained unchanged
in 4 (12.1%) cases.

Conclusion: LF is an aggressive complication of cholesteatomous chronic otitis media. The postoperative prognosis is
correlated to the size and location of the LF.