Management of labyrinthine fistulae secondary to cholesteatoma

Improvements in diagnosis and management of chronic ear disease in general and cholesteatoma in particular have led to a decreased incidence of serious labyrinthine complications. Unfortunately, significant disease still does occur and, if unrecognized, may result in significant morbidity. Labyrinthine fistulae secondary to cholesteatoma cause potentially irreversible symptoms such as hearing loss and vertigo. This study reviews 17 patients who developed labyrinthine fistula secondary to cholesteatoma. Sixteen involved the horizontal semicircular canal and one involved the oval window. The cholesteatoma matrix was removed in all cases and the underlying fistula repaired primarily. Cochlear function was preserved in all patients. Sixteen of 17 patients have had no further difficulty with vertigo beyond the immediate postoperative period. The evaluation and contemporary management of this difficult problem are discussed.