Artikel
Hearing preservation in patients with labyrinthine fistula
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Veröffentlicht: | 22. April 2010 |
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Gliederung
Abstract
Introduction: The management of labyrinthine fistula has been controversially debated.
Methods: Retrospective study on 28 patients with labyrinthine fistulae found during cholesteatoma surgery; in all cases total matrix removal was performed, the fistula covered with bone dust, periostium and/or cartilage. 23 patients received intraoperatively a high dosage of iv steroids about 15 minutes before handling the fistula. As outcome measurements we compared the preoperative and postoperative bone conduction to assess the inner ear function.
Results: The fistula was located on the lateral semicircular canal in 22 patients (78.57%) and at the oval window in 5; one patient had a double localization (superior and lateral semicircular canals). 5 patients (17.85%) had a fistula type I, 8 had type IIa (28.5%), 4 patients (14.4%) presented a type IIB fistula and 6 had a type III (21.40%). Preoperatively the bone conduction displayed an average threshold of 34 dB. Patients treated by steroids showed a preserved or improved bone conduction in almost 70%. Patients with fistulas of the OW and fistulae type IIa on the LSC treated by cortisone experienced a good sensorineural hearing outcome (preservation or significant improvement of the inner ear function) whilst the auditory results for groups IIb and III are inconclusive. Five patients did not receive steroids. Three of them developed a partial sensorineural hearing loss, one got deaf and in one the preoperative hearing level remained unchanged.
Conclusion: Matrix removal over the fistula after a high dosage metilprednisolone administration followed by repair seems to be helpful in preventing permanent inner ear damage. In patients with fistulae on the oval window or type IIa fistulae of the LSC the threshold for bone conduction could be improved.