Introduction The challenge during surgery in patients with labyrinthine fistula lies in the mandatory complete removal of the cholesteatoma and the preservation of inner ear and vestibular function. We evaluated our surgical technique using “under water approach” for complete cholesteatoma resection in contact with fistula, in terms of preservation of inner ear and vestibular function.
Methods This is a retrospective study (2012-2019) where 18 patients with labyrinthine fistula were operated. The patients received systemic cortisone and antibiotics. Canal wall down approach was used and removal of matrix and perimatrix at the fistula was done as the last step during surgery. A mixture of cortisone and antibiotics was continuously superfused onto the surgery area creating a protective area over the fistula and thus avoiding leakage of the perilymph. The pre- and postoperative hearing tests and the vestibular function were then compared.
Results 3 from 18 patients came with inner ear depression and vertigo. The rest had fistula diagnosed preoperatively in CT scan. One patient later had cholesteatoma recurrence. Compared with preoperative bone conduction at 0.25, 0.5, 1, 2, 4, and 8 kHz, 13 cases had a difference less than 5 dB, four patients’ hearing improved more than 10 dB and one patient who was preoperatively deaf received cochlear implantation 6 months later. The average bone and air conduction thresholds at 0.25, 0.5, 1, 2, 4, and 8 kHz had no significant change (p>0.05) with normal vestibular function in all our patients postoperatively.
Conclusion Our data shows that “under water technique” for cholesteatoma removal at the fistula is a safe procedure yielding good results in the preservation of inner ear facilitating complete cholesteatoma removal.
Katrin Reimann
Poster-PDF
A-1405.pdf
