Lateral semicircular canal fistula in cholesteatoma: diagnosis and management.

The objective of this retrospective study was to present the authors' experience on the management of labyrinthine fistula secondary to cholesteatoma. 695 patients, who underwent tympanoplasty for cholesteatoma, in a University Hospital between 1993 and 2013 were reviewed, to select only those with labyrinthine fistulas. 42 patients (6%) had cholesteatoma complicated by fistula of the lateral semicircular canal (LSCC). The following data points were collected: symptoms, pre- and postoperative clinical signs, surgeon, CT scan diagnosis, fistula type, surgical technique, preoperative vestibular function and audiometric outcomes. Most frequent symptoms were unspecific, such as otorrhea, hearing loss and dizziness. However, preoperative high-resolution computed tomography predicted fistula in 88 %. Using the Dornhoffer and Milewski classification, 16 cases (38 %) were identified as stage 1, 22 (52 %) as stage II, and 4 (10 %) as stage III. The choice between open or closed surgical procedure was independent of the type of fistulae. The cholesteatoma matrix was completely removed from the fistula and immediately covered by autogenous material. In eight patients (19 %), the canal was drilled with a diamond burr before sealing with autologous tissue. After surgery, hearing was preserved or improved in 76 % of the patients. There was no statistically significant relationship between the extent of the labyrinthine fistula and the hearing outcome. In conclusion, a complete and nontraumatic removal of the matrix cholesteatoma over the fistula in a one-staged procedure and its sealing with bone dust and fascia temporalis, with sometimes exclusion of the LSCC, is a safe and effective procedure to treat labyrinthine fistula.

"Bleeding polyp" of the nasal septum: an uncommon lesion in adults.

Inflammatory hemangioma of the nasal septum, known as "bleeding polyp," is an uncommon lesion in adults. We report the case of a 20-year-old woman who presented with left nasal hemangioma revealed by unilateral epistaxis and obstruction. The patient had a medical history of septoplasty performed 5 years earlier. This benign tumor can be spontaneous or posttraumatic and occurs in young postpubertal adults or patients over 40 years of age, without a sex preponderance. The site of origin is most frequently the cartilaginous septum. The appearance and clinical signs often mimic malignancy, and a biopsy for histologic confirmation of the diagnosis is crucial. The capillary hemangioma is more frequently observed than the cavernous type. This tumor does not present spontaneous involution, and treatment is based on a surgical excision including the mucosa and the underlying perichondrium, after computed tomographic and/or nuclear magnetic resonance examination.