Authors: MarieFrance Stephenson Issam Saliba
Publish Date: 2011/03/09
Volume: 268, Issue: 12, Pages: 1705-1711
Abstract
The objectives of this study are 1 to evaluate hearing change after complete cholesteatoma resection in the setting of a labyrinthine fistula 2 to assess the sensitivity and specificity of the preoperative CTscan in diagnosing a labyrinthine fistula and 3 to determine the correlation between the type of the labyrinthine fistula and its radiologic size A retrospective chart review of all patients operated for cholesteatoma between 2004 and 2009 was conducted Primary outcome was defined as the average variation in bone conduction thresholds BCTs as well as speech discrimination score SDS after total excision of cholesteatoma causing a labyrinthine fistula We reviewed all preoperative CTscans and operative notes to assess sensitivity and specificity for the diagnosis of a labyrinthine fistula Results show that 317 patients underwent mastoidectomy for cholesteatoma Twentyeight patients were found to have 32 labyrinthine fistulas caused by cholesteatomatous disease affecting the lateral semicircular canal SCC n = 25 the superior SCC n = 5 the posterior SCC n = 1 and the footplate n = 1 Postoperative BCT and SDS 245 dB 866 were neither clinically nor statistically different from preoperative levels 232 dB 875 p = 035 Sensitivity and specificity of the preoperative high resolution 055 mm cuts CTscan was 100 With a fistula of 355 mm in the axial plan a membraneous fistula must be suspected with a sensitivity of 66 and a specificity of 71 Complete matrix resection without suctioning at the site of a cholesteatomatous labyrinthine fistula is a safe and effective management option Highresolution preoperative CTscan is very precise in diagnosing labyrinthine fistula and its radiologic size helps to predict the type of the fistula
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