Labyrinthine fistulas in cholesteatoma

The purpose of the present study was to investigate the clinical features of cases of cholesteatoma with labyrinthine fistulas, and in particular the pre and post-operative bone-conduction (BC). Cholestatoma patients with bone erosion or a defect found in the first stage operation were analyzed. The operations were conducted between 1992 and 1996. The patients were classified into four types, I, IIa, IIb, and III, according to Dornhoffer and Milewski's classification, which is based on different stages in the bone defect. A type I fistula is an erosion of the bony labyrinth with an intact endosteum. Type IIa is accompanied by an opened perilymphatic space with undisturbed perilymph while type IIb has a disturbed perilymph. A Type III fistula is an opened perilymphatic space with a disturbance of the underlying membranous labyrinth. Only 24 patients with type II and type III fistulas were included in this study. The location of the fistulas was the semicircular canals (SCCs) or/and the vestibula in 21 patients and in the cochlea in 3 patients. We examined the fistula by high-resolution computed tomography scan (CT scan) with 1 mm slice and 1 mm width axial-sections in 14 patients. A bone defect in the labyrinth was detected in 10 cases (71.5%) pre-operatively. Pre-operative BC was worse in the patients with cochlear fistulas than in those with fistulas located in SCCs or the vestibula. Within this latter group there were 13 type IIa (group IIa), patients and 8 type IIb or III (group IIb or III) patients. However, there was no difference in the pre-operative BC between these two sub-groups Tympanoplasty was conducted in all 24 patients. The postoperative BC of group IIa and group IIb or III were compared. Two of the 13 patients in group II a (15.4%) and 3 of 8 in group IIb or III (37.5%) had a deteriorated postoperative BC. Statistical analysis revealed that the postoperative BC was more inclined to become worse in patients with advanced stage IIb or III fistulas.