Surgical management of labyrinthine fistula in chronic otitis media with cholesteatoma

Objective: To present the surgical outcomes of complete removal of the matrix of labyrinthine fistulas in a large series of middle ear cholesteatomas. Patients and methods: This is a retrospective study. We analyzed 38 of 778 patients who were operated on for cholesteatoma and were proved to have labyrinthine fistula from 1991 to 2007. For this study, a more aggressive strategy was adopted that compromised immediate total removal of the matrix, regardless of size. To evaluate the safety and efficacy of the procedure, pre and postoperative pure-tone audiometry were compared and the recurrence rate was analyzed. Relevant data from the literature using a wide array of strategies were compared with our results. Results: Only two patients suffered from postoperative hearing deterioration of bone conduction of more than 10. dB HL. There was no relationship between the size of labyrinthine fistulas and postoperative hearing deterioration. Recurrence of labyrinthine fistulas was not found. Conclusions: Total removal of the cholesteatoma matrix in one step is a safe and effective method for the treatment of labyrinthine fistulas.