A case report of middle ear cholesteatoma complicated with labyrinthine fistulaand delayed endolymphatic hydrops / 临床耳鼻咽喉头颈外科杂志

Delayed endolymphatic hydrops （DEH） is a rare disease that causes vertigo and is often misdiagnosed as other vertigo diseases. This article reports on a patient with vertigo who was easily misdiagnosed. The patient was a middle ear cholesteatoma complicated by labyrinthine fistula （LF）; however, his vertigo was episodic vertigo, which could not be explained solely by LF causing labyrinthitis. The possibility of endolymphatic hydrops was suspected, which was confirmed by inner ear magnetic resonance gadolinium imaging. This is the first reported case of middle ear cholesteatoma complicated by LF and DEH. The patient underwent surgical resection of the cholesteatoma and three semicircular canal obstructions at the same time. During two years postoperative follow-up, the patient did not experience a recurrence of vertigo. When diagnosing vertigo diseases, a careful history of vertigo is of utmost importance.

Cholesteatoma labyrinthine fistula: prevalence and impact / Fístula labiríntica por colesteatoma: prevalência e impacto

Abstract Introduction: Labyrinthine fistula is one of the most common complications associated with cholesteatoma. It represents an erosive loss of the endochondral bone overlying the labyrinth. Reasons for cholesteatoma-induced labyrinthine fistula are still poorly understood. Objective: Evaluate patients with cholesteatoma, in order to identify possible risk factors or clinical findings associated with labyrinthine fistula. Secondary objectives were to determine the prevalence of labyrinthine fistula in the study cohort, to analyze the role of computed tomography and to describe the hearing results after surgery. Methods: This retrospective cohort study included patients with an acquired middle ear cholesteatoma in at least one ear with no prior surgery, who underwent audiometry and tomographic examination of the ears or surgery at our institution. Hearing results after surgery were analyzed according to the labyrinthine fistula classification and the employed technique. Results: We analyzed a total of 333 patients, of which 9 (2.7%) had labyrinthine fistula in the lateral semicircular canal. In 8 patients, the fistula was first identified on image studies and confirmed at surgery. In patients with posterior epitympanic and two-route cholesteatomas, the prevalence was 5.0%; and in cases with remaining cholesteatoma growth patterns, the prevalence was 0.6% (p = 0.16). In addition, the prevalence ratio for labyrinthine fistula between patients with and without vertigo was 2.1. Of patients without sensorineural hearing loss before surgery, 80.0% remained with the same bone conduction thresholds, whereas 20.0% progressed to profound hearing loss. Of patients with sensorineural hearing loss before surgery, 33.33% remained with the same hearing impairment, whereas 33.33% showed improvement of the bone conduction thresholds' Pure Tone Average. Conclusion: Labyrinthine fistula must be ruled out prior to ear surgery, particularly in cases of posterior epitympanic or two-route cholesteatoma. Computed tomography is a good diagnostic modality for lateral semicircular canal fistula. Sensorineural hearing loss can occur post-surgically, even in previously unaffected patients despite the technique employed.

Resumo Introdução: A fístula labiríntica é uma das complicações mais comuns associadas ao colesteatoma. Representa uma perda erosiva do osso endocondral que recobre o labirinto. As razões para a ocorrência da fístula labiríntica induzida pelo colesteatoma ainda são mal compreendidas. Objetivo: Avaliar pacientes com colesteatoma, a fim de identificar possíveis fatores de risco ou achados clínicos associados à fístula labiríntica. Os objetivos secundários foram determinar a prevalência de fístula labiríntica no estudo de coorte, analisar o papel da tomografia computadorizada e descrever os resultados auditivos após a cirurgia. Método: Este foi um estudo de coorte retrospectivo. Foram incluídos pacientes com colesteatoma adquirido de orelha média em pelo menos um lado sem cirurgia prévia que haviam sido submetidos à audiometria e tomografia computadorizada de orelha ou cirurgia em nossa instituição. Os resultados auditivos após a cirurgia foram analisados de acordo com a classificação de fístula labiríntica e da técnica empregada. Resultados: Analisamos um total de 333 pacientes, dos quais 9 (2,7%) apresentavam fístula labiríntica no canal semicircular lateral. Em 8 pacientes, a fístula foi identificada na tomografia computadorizada e confirmada durante a cirurgia. Em pacientes com colesteatomas epitimpânicos posteriores e de via dupla, a prevalência foi de 5,0%; e nos casos com padrão de crescimento de colesteatoma remanescente, a prevalência foi de 0,6% (p = 0,16). Além disso, a taxa de prevalência de fístula labiríntica entre pacientes com e sem vertigem foi de 2,1. Dos pacientes sem perda auditiva neurossensorial antes da cirurgia, 80,0% permaneceram com os mesmos limiares de condução óssea, enquanto 20,0% progrediram para perda auditiva profunda. Dos pacientes com perda auditiva neurossensorial antes da cirurgia, 33,33% permaneceram com a mesma deficiência auditiva, enquanto 33,33% apresentaram melhora da média de dos limiares de condução óssea aos tons puros. Conclusão: A fístula labiríntica deve ser descartada antes do procedimento cirúrgico, particularmente nos casos de colesteatomas epitimpânicos posteriores e de dupla via. A tomografia computadorizada é uma boa modalidade diagnóstica para a fístula do canal semicircular lateral. A perda auditiva neurossensorial pode ocorrer pós-cirurgicamente, mesmo em pacientes previamente não afetados, a despeito da técnica empregada.

Two Cases of Traumatic Stapedial Dislocation Caused by a Cotton Tipped Swab / 대한이비인후과학회지

A stapedial dislocation is a rare complication of ossicular trauma that is most commonly caused by direct, penetrating injury to the external ear canal. In this type of ossicular dislocation, patients usually suffer from cochleovestibular symptoms including progressive sensorineural hearing loss, conductive hearing loss, tinnitus, and vertigo. We present rare cases of internal stapedial dislocation after penetrating trauma, which resulted in the preservation of bone conduction hearing thresholds and complete resolution of the vestibular symptoms after an urgent repair. We have also reviewed the literature to determine the optimal management of stapedial dislocations.

A Case of Labyrinthine Fistula by Cholesteatoma Mimicking Lateral Canal Benign Paroxysmal Positional Vertigo

Acute peripheral vestibulopathy, of which the chief complaint is positional vertigo, comprises benign paroxysmal positional vertigo (BPPV), labyrinthitis, labyrinthine fistula, and cerebellopontine angle tumors. Since the typical presentation of labyrinthine fistulas may be sensorineural hearing loss, positional vertigo, or disequilibrium, it is often difficult to distinguish from BPPV or Meniere's disease. Herein we report a 61-year-old female patient with typical symptoms and signs attributable to geotropic type variant of the lateral semicircular canal BPPV on the left side, who eventually was confirmed as having a labyrinthine fistula from chronic otitis media with cholesteatoma on the left side. This is another case where, even in the presence of isolated vertigo showing typical findings of acute peripheral vestibulopathy, other otologic symptoms and signs must not be overlooked.

MRI Findings of a Cholesteatomatous Labyrinthine Fistula Showing Abnormal Inner Ear Enhancement / 대한평형의학회지

A 59-year-old male patient presented with sudden onset of vertigo and hearing loss. Labyrinthitis due to lateral semicircular canal fistula caused by cholesteamatous otitis media was suspected from temporal bone computed tomography (CT) and clinical symptoms. The patient was treated with canal wall down mastoidectomy with removal of the cholesteatoma and lateral semicircular canal occlusion. Preoperative gadolinium-enhanced magnetic resonance imaging (MRI) images of the inner ear revealed increased signal in the cochlea as well as vestibule. Correlation of the MRI findings and the inner ear involvement in labyrinthine fistula is discussed.

A Case of Cholesteatoma Extended Both into the Cochlea and IAC / 대한이비인후과학회지

Labyrinthine fistula caused by cholesteatoma can make various complications according to the site of the lesion. The lateral canal, superior canal ampulla, posterior canal and promontory of the cochlea are the common areas of fistulization. However, invasion into the cochlea or internal auditory canal (IAC) is very rare. We have experienced a case of cholesteatoma extending into the cochlea and IAC, which was successfully treated via the transotic approach. Herein we report this case with a review of literature

Analysis of Vertigo in Labyrinthine Fistula Secondary to Cholesteatoma

BACKGROUND AND OBJECTIVES: Labyrinthine fistula is one of the common complication of the chronic otitis media with cholesteatoma. Disruption of the labyrinthine bone can lead to hearing loss and/or vestibular disturbance. This study aimed to evaluate postoperative vertigo result in patient with labyrinthine fistula and efficacy of vestibular function test for diagnosis. MATERIALS AND METHOD: A retrospective study of the clinical records of 13 patients who were operated for chronic otitis media with cholesteatoma, suspected to have secondary labyrinthine fistula, from January 2001 through June 2003 in Gachon medical school Gil hospital. All patients were evaluated by Fistular test, Vestibular function test, high resolution Temporal bone CT, Pure tone audiometry preoperatively. Vertigo was assessed by Disability Scale. RESULTS: Canal wall down mastoidectomy were applied in all ears. Labyrinthine fistulas were confirmed in 8 patients during operation. Fistular group had higher rate of peripheral vestibular injury than no-fistular group's in vestibulo-ocular reflex. Fistula cases have high average score (2.9) than non-fistula's (1.6) in Vertigo scale preoperatively. In post-operation, the average score was 0.25 in fistular cases and 0.4 in non-fistula cases. 2 cases presented positive fistular test result (25.0%) CONCLUSION: Although Vertigo was more severe in patients who had fistula, in post-operation, symptoms could be relieved a lot. Vestibular function test had efficacy for diagnosis of labyrinthine fistula in preoperative.

Postoperative Newbone Formation of Horizontal Semicircular Canal Fistulae in Chronic Otitis Media with Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: It is not uncommon to encounter labyrinthine fistulae during cholesteatoma surgeries. The aim of this study is to evaluate the postoperative changes of labyrinthine fistulae after removal of matrix and closure by bone pate with fibrin glue. MATERIALS AND METHODS: We evaluated 25 patients who had operatively closed labyrinthine fistulae of horizontal semicircular canal in the chronic otitis media with cholesteatoma using CT. Seven human temporal bones with labyrinthine fistulae were studied. The fistulae were closed with bone pate using fibrin glue and fascia. RESULTS: Postoperative CTs show that, in all cases, the layer closing the fistulae was indistinguishable from the surrounding bony otic capsule. CONCLUSIONS: Canal down mastoidectomy with closure of fistulae using bone pate with fascia were effective for new bone formation at the fistulae site.

Hearing Preserved Four Cases of Iatrogenic Labyrinthine Fistula Treatment / 대한이비인후과학회지

Evaluation of postoperative hearing acuity and equilibrium was performed in four patients with labyrinthine fistula caused by iatrogenic procedure. Surgical trauma inflicted upon the membranous labyrinth is an uncommon, but often catastrophic, complication of chronic ear surgery. The most vulnerable areas are the oval window and the lateral semicircular canal. Methods of injury include subluxation of the foot plate, fracture of the lateral canal by drill or chisel, and accidental opening of the labyrinth. Three cases of fistula of the lateral and posterior canal during ear surgery are presented. All of three occured while drilling. The other one occured due to iatrogenic stapedectomy. The interrupted semicircular canals were obliterated firmly with autologous materials such as fascia, perichondrium, bone chips, and cartilage. These cases were documented by pre and post operative audiograms, vestibular function tests. One interesting finding was that none of these cases were compromised cochlear function. The dictum that an accidentally opened labyrinth will automatically result in a dead ear is shown to be not necessarily true. These cases indicates that manipulation of the semicircular canal with awareness can be conducted without damaging the cochlear function, and that the treatment of labyrinthine fistulas shoud be performed very carefully but not so conservatively as to lead to future problems.

Labyrinthine Fistula Reviewed During Chronic Ear Surgery / 听力学及言语疾病杂志

Fifty-one cases of labyrinthine fistula had been reviewed in 1990-1997 during chronic ear surgery. All cases had a lateral semicircular canal fistula and one case had an additional posterior semicircula canal fistula. There was no relationship between the size of labyrinthine fistula and preoperative bone conduction. 34 cases had chronic otitis media with cholesteatoma,the matrix of the cholesteatoma was completely removed in all patients except one case. Preoperative bone conducton hearing was preserved after removal of cholesteatoma matrix in all cases except the one case.