TY - JOUR
T1 - Labyrinthine fistulas
T2 - Surgical outcomes and an additional diagnostic strategy
AU - Westerhout, Sanne F
AU - Straatman, Louise V
AU - Dankbaar, Jan Willem
AU - Thomeer, Hans G X M
N1 - Funding Information:
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. All names authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. All authors contributed to the study conception and design. SW analyzed and interpreted the patient data and was a major contributor in writing the manuscript. HT and LS performed measurements of the CT images and were major contributors to the manuscript. JWD performed measurements of the CT images and also of the MRI scans. All authors read and approved the final manuscript. Approval by the Ethical Committee was not required for this study under Dutch Law (MvdL/mb/21/500229). Written informed consent that allowed the use of their entire bodies for educational and research purposes was obtained during life from the persons that were used for this study. All data generated or analyzed during this study are available from the corresponding author on reasonable request.
Publisher Copyright:
© 2022 The Authors
PY - 2022/5
Y1 - 2022/5
N2 - PURPOSE: To evaluate perioperative findings and audiological and vestibular outcomes in patients operated for cholesteatoma with labyrinthine fistulas. Also to assess radiological fistula size.MATERIALS AND METHODS: Patients who underwent surgery for a labyrinthine fistula caused by a cholesteatoma between 2015 and 2020 in a tertiary referral center were retrospectively investigated. Fistula size was determined on preoperative CT scan. Bone and air conduction pure tone average thresholds were obtained pre- and postoperatively. Clinical outcomes, such as vertigo and otorrea were also evaluated. Main purpose was to determine whether there is a correlation between fistula size and postoperative hearing. Furthermore, perioperative findings and vestibular outcomes are evaluated.RESULTS: 21 patients (22 cases) with a labyrinthine fistula were included. There was no significant change after surgery in bone conduction pure tone average (preoperatively 27.6 dB ± 26.7; postoperatively 30.3 dB ± 34.3; p = 0.628) or air conduction pure tone average (preoperatively 58.7 dB ± 24.3; postoperatively 60.2 dB ± 28.3; p = 0.816). Fistula size was not correlated to postoperative hearing outcome. There were two patients with membranous labyrinth invasion: one patient was deaf preoperatively, the other acquired total sensorineural hearing loss after surgery.CONCLUSIONS: Sensorineural hearing loss after cholesteatoma surgery with labyrinthine fistula is rare. Fistula size and postoperative hearing loss are not correlated, however, membranous labyrinthine invasion seems to be related to poor postoperative hearing outcomes. Therefore, additional preoperative radiological work up, by MRI scan, in selected cases is advocated to guide the surgeon to optimize preoperative counselling.
AB - PURPOSE: To evaluate perioperative findings and audiological and vestibular outcomes in patients operated for cholesteatoma with labyrinthine fistulas. Also to assess radiological fistula size.MATERIALS AND METHODS: Patients who underwent surgery for a labyrinthine fistula caused by a cholesteatoma between 2015 and 2020 in a tertiary referral center were retrospectively investigated. Fistula size was determined on preoperative CT scan. Bone and air conduction pure tone average thresholds were obtained pre- and postoperatively. Clinical outcomes, such as vertigo and otorrea were also evaluated. Main purpose was to determine whether there is a correlation between fistula size and postoperative hearing. Furthermore, perioperative findings and vestibular outcomes are evaluated.RESULTS: 21 patients (22 cases) with a labyrinthine fistula were included. There was no significant change after surgery in bone conduction pure tone average (preoperatively 27.6 dB ± 26.7; postoperatively 30.3 dB ± 34.3; p = 0.628) or air conduction pure tone average (preoperatively 58.7 dB ± 24.3; postoperatively 60.2 dB ± 28.3; p = 0.816). Fistula size was not correlated to postoperative hearing outcome. There were two patients with membranous labyrinth invasion: one patient was deaf preoperatively, the other acquired total sensorineural hearing loss after surgery.CONCLUSIONS: Sensorineural hearing loss after cholesteatoma surgery with labyrinthine fistula is rare. Fistula size and postoperative hearing loss are not correlated, however, membranous labyrinthine invasion seems to be related to poor postoperative hearing outcomes. Therefore, additional preoperative radiological work up, by MRI scan, in selected cases is advocated to guide the surgeon to optimize preoperative counselling.
KW - Cholesteatoma, Middle Ear/surgery
KW - Fistula/diagnostic imaging
KW - Hearing Loss, Sensorineural/complications
KW - Humans
KW - Labyrinth Diseases/diagnostic imaging
KW - Retrospective Studies
KW - Treatment Outcome
KW - Vestibular Diseases/complications
KW - Vestibule, Labyrinth
KW - Skull base
KW - Inner ear pathology
KW - Sensorineural hearing los
KW - Cholesteatoma
KW - Labyrinthine fistula
UR - https://www.scopus.com/pages/publications/85127472092
U2 - 10.1016/j.amjoto.2022.103441
DO - 10.1016/j.amjoto.2022.103441
M3 - Article
C2 - 35397381
SN - 0196-0709
VL - 43
SP - 1
EP - 7
JO - American journal of otolaryngology
JF - American journal of otolaryngology
IS - 3
M1 - 103441
ER -