抄録
We retrospectively studied the hearing outcomes in 35 patients (35 ears) with cholesteatomatous otitis media complicated by labyrinthine fistula, who underwent tympanomastoidectomy at our department between 2007 and 2016. The patients consisted of 25 men and 10 women, with a mean age of 62.3 years (range, 17 to 82 years). Such cases accounted for 11.8% of all cholesteatoma operations during this period. The fistula was located in the lateral semicircular canal in 32 cases (91.4%). The cholesteatoma was totally removed in a one-stage operation in all cases, and the fistula was closed with bone chips, bone powder and temporal fascia. The depth of the fistula was classified as Dornhoffer’s grade I, II and III in 24, 9 and 2 cases, respectively. Ossicular reconstruction was performed in 13 cases: type I in 4 cases, type II in one case, and type III in 8 cases. Dexamethasone was administered intravenously in 22 cases in the perioperative period.
No significant change of either air- or bone-conduction hearing level was observed postoperatively. Air- and bone-conduction hearing deteriorated by ≥10 dB in 4 (11.4%) and 3 (8.6%) cases, respectively. Negative bone-conduction hearing gain was significantly more frequent in patients aged ≥60 years than in those aged ≤59 years (14/24 vs. 1/11, P=0.010). Bone-conduction hearing gain tended to be negatively correlated with the patients’ age (r=-0.323, P=0.058). Negative air- or bone-conduction hearing gain was not associated with fistula symptoms, steroid use, depth of the fistula, ossicular reconstruction or postoperative vertigo. Of the 13 patients who underwent ossicular reconstruction, 5 (38.5%) showed successful hearing improvement according to the criteria of the Otological Society of Japan.
These results indicate that hearing was satisfactorily preserved overall, but older patients were at a higher risk of development of inner ear damage after the removal of a cholesteatoma with a labyrinthine fistula. Furthermore, the results also suggested that steroid use, which did not prove to be helpful for hearing preservation, should be reconsidered.
