Surgical Management of the Labyrinthine Fistula Complicating Chronic Otitis Media with or without Cholesteatoma

Objectives: To present our most recent experience on the diagnosis and treatment of the labyrinthine fistula. The relative data are compared with those of our past experiences adopting the same modality of presenting the results. Methods: The clinical and surgical records of 334 patients affected with chronic otitis media with or without cholesteatoma were analyzed to evaluate the frequency, site, and size of the labyrinthine fistulae. In this study, a more agressive strategy was adopted that comprised immediate total removal of the cholesteatoma matrix and the surrounding inflammatory tissues even when they involved the membranous labyrinth. Results: Sixteen labyrinthine fistulae were found, only one of which was in a patient with chronic otitis media without cholesteatoma. Only one patient suffered from postoperative hearing deterioration of the bone conduction above 10 dB. The fistulae were smaller in size than in the previous survey, although the total incidence was slightly higher. Conclusions: Imaging techniques have demonstrated a favourable clinical impact on the diagnosis regarding the size and involvement of one or more anatomic structures of the otic capsule, not on the frequency percentage of fistulae. Total removal of the cholesteatoma matrix in one step, also combined with partial labyrinthectomy, yields satisfactory hearing results. To obtain successful outcomes, it is essential to respect certain fundamental precautions.