Management of Cochlear Fistula and the Role of Hearing: a Five-case Report

Overview

Journal Acta Otorhinolaryngol Ital

Specialty Otorhinolaryngology

Date 2021 Dec 20

PMID 34928267

Authors

Maurizio Falcioni

Marco Govoni

Enrico Pasanisi

Filippo Di Lella

Affiliations

Soon will be listed here.

Abstract

Objective: Cochlear fistula (CF) is a rare finding, usually associated with extensive middle ear cholesteatoma. There is agreement on the fact that removing the cholesteatoma matrix on a CF exposes the ear to a high risk of sensorineural hearing loss or dead ear. The aim of the study is to describe the presentation, possible treatment strategies and related outcomes for patients with CF in chronic otitis media (COM).

Methods: The study considers a retrospective case series of patients with CF diagnosis supported by CT-scan and intraoperative/otoscopic evidence.

Results: Five cases of CF were identified, 4 associated with cholesteatoma and 1 associated with non-cholesteatomatous COM. Two patients presenting with anacusis underwent a subtotal petrosectomy. Two patients with useful hearing underwent a radical mastoidectomy in order to preserve the cholesteatoma matrix on the promontorium. One patient with good hearing and COM was treated conservatively.

Conclusions: Conservative management should be considered for rare cases of CF in COM with residual hearing. Matrix preservation through radical/modified radical mastoidectomy is strongly advised in the presence of useful preoperative bone conduction. Subtotal petrosectomy should be considered the preferred option in presence of cholesteatoma with preoperative profound hearing loss.

References

Yang J, Chi F, Han Z, Huang Y, Li Y . Clinical characteristics of patients with labyrinthine fistulae caused by middle ear cholesteatoma. Chin Med J (Engl). 2013; 126(11):2116-9. View

Fuse T, Tada Y, Aoyagi M, Sugai Y . CT detection of facial canal dehiscence and semicircular canal fistula: comparison with surgical findings. J Comput Assist Tomogr. 1996; 20(2):221-4. DOI: 10.1097/00004728-199603000-00009. View

Prasad S, Roustan V, Piras G, Caruso A, Lauda L, Sanna M . Subtotal petrosectomy: Surgical technique, indications, outcomes, and comprehensive review of literature. Laryngoscope. 2017; 127(12):2833-2842. DOI: 10.1002/lary.26533. View

Meyer A, Bouchetemble P, Costentin B, Dehesdin D, Lerosey Y, Marie J . Lateral semicircular canal fistula in cholesteatoma: diagnosis and management. Eur Arch Otorhinolaryngol. 2015; 273(8):2055-63. DOI: 10.1007/s00405-015-3775-6. View

Iaccarino I, Bozzetti F, Piccioni L, Falcioni M . A case of external auditory canal osteoma complicated with cholesteatoma, mastoiditis, labyrinthitis and internal auditory canal pachymeningitis. Acta Otorhinolaryngol Ital. 2019; 39(5):358-362. PMC: 6843583. DOI: 10.14639/0392-100X-1547. View

Palva T, Karja J, Palva A . Opening of the labyrinth during chronic ear surgery. Arch Otolaryngol. 1971; 93(1):75-8. DOI: 10.1001/archotol.1971.00770060107014. View

Sagar P, Devaraja K, Kumar R, Bolu S, Sharma S . Cholesteatoma Induced Labyrinthine Fistula: Is Aggressiveness in Removing Disease Justified?. Indian J Otolaryngol Head Neck Surg. 2017; 69(2):204-209. PMC: 5446341. DOI: 10.1007/s12070-017-1072-y. View

Delrue S, De Foer B, van Dinther J, Zarowski A, Bernaerts A, Vanspauwen R . The Value of Diffusion-Weighted MRI in the Long-term follow-up After Subtotal Petrosectomy for Extensive Cholesteatoma and Chronic Suppurative Otitis Media. Otol Neurotol. 2018; 40(1):e25-e31. DOI: 10.1097/MAO.0000000000002049. View

Hahn Y, Bojrab D . Cochlear fistula in a noncholesteatomatous ear. Ear Nose Throat J. 2014; 93(9):E9-E10. DOI: 10.1177/014556131409300903. View

10.

Misale P, Lepcha A, Chandrasekharan R, Manusrut M . Labyrinthine Fistulae in Squamosal Type of Chronic Otitis Media: Therapeutic Outcome. Iran J Otorhinolaryngol. 2019; 31(104):167-172. PMC: 6556750. View

11.

Gacek R . The surgical management of labyrinthine fistulae in chronic otitis media with cholesteatoma. Ann Otol Rhinol Laryngol. 1974; 83:Suppl 10:1-19. View

12.

Lim J, Gangal A, Gluth M . Surgery for Cholesteatomatous Labyrinthine Fistula. Ann Otol Rhinol Laryngol. 2017; 126(3):205-215. DOI: 10.1177/0003489416683193. View

13.

Hamzei M, Ventriglia G, Hagnia M, Antonopolous A, Bernal-Sprekelsen M, Dazert S . Osteoclast stimulating and differentiating factors in human cholesteatoma. Laryngoscope. 2003; 113(3):436-42. DOI: 10.1097/00005537-200303000-00009. View

14.

Falcioni M, Lauda L . Cochlear fistula in recurrent cholesteatoma. Otol Neurotol. 2006; 27(2):284. DOI: 10.1097/01.mao.0000194817.92426.64. View

15.

Kang W, Song C, Yoon T . Cochlear implantations in patients with Cochlear fistulae. Otolaryngol Head Neck Surg. 2010; 143(3):463-4. DOI: 10.1016/j.otohns.2010.04.023. View

16.

Copeland B, Buchman C . Management of labyrinthine fistulae in chronic ear surgery. Am J Otolaryngol. 2003; 24(1):51-60. DOI: 10.1053/ajot.2003.10. View

17.

Redaelli de Zinis L, Campovecchi C, Gadola E . Fistula of the cochlear labyrinth in noncholesteatomatous chronic otitis media. Otol Neurotol. 2005; 26(5):830-3. DOI: 10.1097/01.mao.0000169638.48193.b2. View

18.

Jang C, Merchant S . Histopathology of labyrinthine fistulae in chronic otitis media with clinical implications. Am J Otol. 1997; 18(1):15-25. View

19.

Sanna M, Zini C, Gamoletti R, Taibah A, Russo A, Scandellari R . Closed versus open technique in the management of labyrinthine fistulae. Am J Otol. 1988; 9(6):470-5. View

20.

Kwon C, Choi J, Woo H . Cochlear Fistula in Chronic Otitis Media without Cholesteatoma. J Audiol Otol. 2017; 21(2):112-114. PMC: 5516695. DOI: 10.7874/jao.2017.21.2.112. View