gms | German Medical Science

Labyrinthine fistulas are rare complications of large cholesteatoma. The perioperative management depends on the expected complications. We report two cases of labyrinthine fistula which presented during cholesteatoma surgery. Further we evaluate the postoperative consequences in 34 patients who were treated in our department during the last 10 years: The actual symptoms had appeared only weeks before admission presented mostly as vertigo, otorrhea and recurrent acute otitis. In addition all patients had suffered from hearing loss over years. 17 patients had already undergone surgery in the same ear. Due to the size of the cholesteatoma in 33 of 34 patients mastoidectomy was performed in canal wall down technique. The fistulas were occluded using cartilage and connective tissue. Postoperatively we found an improved hearing level in 13 patients, 7 patients had an hearing impairment of 15–25dB, 2 patients had an impairment of 50–80dB and 3 patients suffered from complete hearing loss. 2 Patients developed facial nerve paresis. In four patients we found newly occurred vertigo with nystagmus. Surgery of cholesteatoma is performed to remove the progressive destructing inflammatory process. The risk of postoperative hearing impairment is particularly high in cholesteatoma which have reached the equilibrium organ. The patients have to be informed about this fact thoroughly before undergoing surgery.