Labyrinthine Fistulas in cholesteatoma : Surgical outcome on auditory function.

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Published Feb 1, 2025
https://doi.org/10.62438/tunismed.v103i2.5191
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Vol. 103 No. 2 (2025): Tunis Med Feb 2025

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Maamoun Kriaa
ENT and CCF Department - La Rabta Hospital, Tunis.Tunisia
Rim Bechraoui
ENT and CCF Department - La Rabta Hospital, Tunis.Tunisia
Rihab Lahmer
ENT and CCF Department - La Rabta Hospital, Tunis, Tunisia
Maha Mejbri
ENT and CCF Department - La Rabta Hospital, Tunis, Tunisia
Maissa Lajhouri
ENT and CCF Department - La Rabta Hospital, Tunis, Tunisia
Najeh Beltaief
ENT and CCF Department - La Rabta Hospital, Tunis, Tunisia

Abstract

Introduction: A labyrinthine fistula (LF) is a challenging complication associated with cholesteatomatous chronic otitis media (CCOM).


Aim: To describe the clinical and audiometric characteristics of patients with cholesteatomatous LF and to evaluate the postoperative outcomes.


Methods: This was a retrospective study of 46 cases of LF, among 555 patients who underwent surgical treatment for CCOM at the Otolaryngology department of La Rabta Hospital, from 2010 to 2020.


Results: The mean age was 43.67 years. The incidence of LF was 8.3%. The most frequent symptoms were otorrhea and hearing loss (87%). Vertigo was present in 43.5% of patients. Facial nerve paralysis was observed in 5 patients (10.9%).


Preoperative tonal audiometry showed hearing impairment in all cases, with no significant relationship between bone conduction hearing thresholds and the type of fistula (p: 0.16).


LF diagnosis was made intraoperatively, involving the lateral semicircular canal (LSCC) in all cases, with or without other locations.


Favorable hearing outcome was noted in 73,9% of patients, with improvement of vestibular signs in all cases. There was no correlation between the fistula size and postoperative hearing loss (p: 0.09).


Conclusion : Cholesteatomatous labyrinthine fistulas pose a complex challenge in managing middle ear pathologies. Typically, labyrinthine fistula is managed by one stage total removal of cholesteatoma matrix on the fistula, leading to satisfactory auditory and vestibular outcomes.

Keywords:

Fistula, Labyrinth, Cholesteatoma, Complications, Therapeutics

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