Management of labyrinthine fistulae in Kyoto University Hospital

• Published in: Acta oto-laryngologica Vol. 130; no. S563; pp. 16 - 19
• Main Authors: Yamamoto, Norio, Fujimura, Shintaro, Ogino, Eriko, Hiraumi, Harukazu, Sakamoto, Tatsunori, Ito, Juichi
• Format: Journal Article
• Language: English
• Published: Norway Informa Healthcare 01-11-2010; Taylor & Francis
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Cholesteatoma - complications; Cholesteatoma - diagnosis; Cholesteatoma - therapy; Cohort Studies; complete removal of the matrix; Female; Fistula - diagnosis; Fistula - etiology; Fistula - surgery; High resolution computed tomography; Hospitals, University; Humans; Japan; Labyrinth Diseases - diagnosis; Labyrinth Diseases - etiology; Labyrinth Diseases - surgery; Male; Mastoid - surgery; Middle Aged; Otitis Media - complications; Otitis Media - diagnosis; Otitis Media - therapy; preservation of bone conduction hearing; Retrospective Studies; Treatment Outcome; Young Adult; Japan
• ISSN: 0001-6489; 0365-5237; 1651-2251
• DOI: 10.3109/00016489.2010.489232

Abstract
Conclusion: In cases of labyrinthine fistulae, we performed complete removal of the cholesteatoma matrix in a one-stage procedure, resulting in a satisfactory bone conduction (BC) hearing preservation rate. Preoperative evaluation of labyrinthine fistulae using high resolution computed tomography (HRCT) detected 86% of cases, and this contributed to favorable results achieved with the surgical treatment of labyrinthine fistulae. We aimed to review cases of labyrinthine fistulae to summarize their outcomes and establish standards of management. Methods: This was a retrospective chart review of 22 patients with labyrinthine fistulae at Kyoto University Hospital from 2001 to 2009. Patient background (age and sex), location and stage of the fistulae, facial nerve status, preoperative and postoperative BC hearing levels, preoperative CT diagnosis, and surgical procedures were analyzed. Results: The incidence rate of the labyrinthine fistulae was 11.2%. All but one patient had labyrinthine fistula due to cholesteatoma. The fistulae were found in the lateral semicircular canal in 17 cases (77%) and in multiple organs in 4 cases (18%). The BC hearing level was preoperatively scaled out in seven cases. Preoperative HRCT scan revealed the presence of fistulae in 19 cases (86%). For all cases of cholesteatoma, the matrix was completely removed in a one-stage procedure and the fistulae were sealed using bone pate, temporal fascia, and temporal bones. Of the 15 cases with residual BC hearing ability, BC hearing was preserved in up to 12 cases. Two cases with postoperative deterioration of BC hearing had stage 4 fistulae in the cochleae.