Labyrinthine fistula as a complication of cholesteatoma

Hypothesis: The objective of this study was to present the authors' experience in the management of labyrinthine fistula caused by cholesteatoma. Methods: The clinical charts of 92 patients who underwent surgical procedures for cholesteatoma complicated by labyrinthine fistula between 1979 and 1995 were reviewed retrospectively. In this period, 1,205 patients were operated on for cholesteatoma. In each patient, the site and size of the fistula were evaluated during surgery and the hearing thresholds were compared before and after surgery. Results: The fistula involved the lateral semicircular canal in 71 patients. Multiple fistulas were observed in nine patients. Postoperative hearing levels were unchanged or improved in 83.7% of patients. Comparison between hearing outcomes and size of the fistula showed better findings when smaller size fistulas were found. No significant differences between open and closed techniques were detected. Favorable outcomes were obtained in patients treated with surgical obliteration of the interrupted labyrinth. Conclusions: The current study confirmed that careful manipulation of the labyrinthine fistula is mandatory to preserve hearing functions for these patients. According to the authors' experience, the future trend for fistula treatment could be directed toward less conservative techniques compared with the previous indications favoring methods of interruption and subsequent obliteration of the semicircular canals.