抄録
The surgical management of labyrinthine fistula caused by cholesteatoma is still controversial. We analyzed the clinical features, surgical management and postoperative hearing of 41 patient with labyrinthine fistula. Before the operation, about 40% had bone conduction within 20dB of normal, and only three patients were totally deaf. Three surgical approaches were employed for the labyrinthine fistula in the first stage operation: 1) complete removal of the cholesteatoma matrix followed by closing of the fistula, 2) leaving the matrix on the fistula in situ, and 3) leaving the subepithelial granulation tissue in situ with removal of the cholesteatoma matrix. Of the 23 patients treated with total removal of matrix at the first operation, three became totally deaf and bone conduction deteriorated in three others. On the other hand, no postoperative deterioration of bone conduction was observed in those with matrix or granulation tissue left in situ. In the former group, pathogenic bacteria were frequently isolated from patients with deterioration of bone conduction, indicating that the inner ear damage was caused by bacterial infection of a labyrinth through the fistula. We conclude that the labyrinthine fistula should be treated in a second stage operation after inflammation has subsided, if the ear has definite infection and/or inflammation at the first stage.
