Labyrinthine Fistulas in cholesteatoma : Surgical outcome on auditory function.

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.