Management of Labyrinthine Fistula in Cholesteatoma Otitis Surgery

Introduction: Labyrinthine fistula constitutes a potentially severe complication of cholesteatoma otitis media, because of its consequences on cochleovestibular function and the association to other possible complications. Material and Methods: We report a retrospective study of approximately 14 cases of labyrinthine fistula operated at the ENT department of Tunis, Tunisia between 2008 and 2013. Results: We analyzed 14 cases (8 men and 6 women) of cholesteatoma otitis media complicated by a labyrinthine fistula. The fistula involved the lateral semicircular canal in all the cases. The patients were classified according to Dornhoffer and Milewski's classification, which is based on different stages in the bone defect. We included 10 cases of type II and 4 patients of type III. The bone defect of the labyrinth was detected in eight cases by the preoperative temporal bone computed tomography. Nine patients underwent a one-stage surgery by performing a canal wall down technique with the obliteration of the fistula by fascia and tissue glue. In five cases, a canal wall up technique was performed and the fistula was treated in the second stage surgery (second look). The long-term outcome was favorable in all the cases. Conclusion: Surgical management of labyrinthine fistula associated to cholesteatoma otitis media depends on the local conditions and the choice and preferences of the surgeon. A high resolution CT scan may diagnose these complications preoperatively.