Principles of safe surgery in patients with chronic suppurative otitis media complicated by labyrinthine fistula
- Authors: Kunelskaya N.L.1,2, Garov E.V.1,2, Moseykina L.A.1, Bavin K.S.1, Chugunova M.A.1, Pryahina M.A.1, Baytemirova N.N.2
-
Affiliations:
- The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute
- The Russian National Research Medical University named after N.I. Pirogov
- Issue: Vol 30, No 6 (2024)
- Pages: 571-579
- Section: Original Research Articles
- Submitted: 06.06.2024
- Accepted: 27.11.2024
- Published: 29.12.2024
- URL: https://medjrf.com/0869-2106/article/view/633266
- DOI: https://doi.org/10.17816/medjrf633266
- ID: 633266
Cite item
Abstract
BACKGROUND: Middle ear surgery always presents some risks to the auditory and vestibular systems. These risks multiply when inflammation affects the inner ear structures or when the latter needs treatment. Chronic suppurative otitis media (CSOM) complicated by labyrinthine fistula (LF) presents both of these factors, thus the most delicate manipulations and a well-defined treatment algorithm are required to preserve the systems integrity.
AIM: To increase the effectiveness of surgical treatment in patients with CSOM complicated by LF.
MATERIALS AND METHODS: A total of 62 patients with CSOM complicated by LF underwent surgery. Examinations included otorhinolaryngological evaluation with otomicroscopy, computed tomography of the temporal bones, pure tone audiometry, vestibulometry with a video head impulse test, and the Dizziness Handicap Inventory. The examination results were evaluated over time at Day 3, 1 and 6 months after surgery.
Canal wall up mastoidectomy (n=8), multilayer closure (n=25), fistula sealing (n=19), and selective laser partitioning of the labyrinth (n=10) were performed to close LFs. In case of a complete erosion of the bony labyrinth, dexamethasone solution was administered into the LF lumen and/or vestibule in 31 patients during surgery, and systemic glucocorticoids were used postoperatively.
RESULTS: Dizziness was reported by 41 patients in the early postoperative period, 6 patients during the long-term follow-up (>2 years), and 25 patients before surgery (40.3%). Postoperatively the difference between bone-conduction thresholds did not exceed 10 dB, regardless of the LF surgery technique. Hearing loss was observed in 2 cases (3%) of multiple LFs. Based on the study results, principles of safe LF surgery in patients with CSOM and indications for techniques to close a bony defect of the semicircular canal were established.
CONCLUSION: Before surgery 46.7% patients with CSOM and cholesteatoma complicated by LF have no vestibular symptoms. Postoperative cochleovestibular disorders in these patients largely depend on the correct technique to close LF and drug therapy after surgery. Principles of safe LF surgery using different techniques together with intra- and postoperative glucocorticoids minimize the risk of cochleovestibular disorders.
Full Text

About the authors
Natalia L. Kunelskaya
The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute; The Russian National Research Medical University named after N.I. Pirogov
Email: nlkun@mail.ru
ORCID iD: 0000-0002-1001-2609
SPIN-code: 9282-6970
MD, Dr. Sci. (Medicine), Professor
Russian Federation, Moscow; MoscowEvgenii V. Garov
The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute; The Russian National Research Medical University named after N.I. Pirogov
Email: egarov@yandex.ru
ORCID iD: 0000-0003-2473-3113
SPIN-code: 1566-9994
MD, Dr. Sci. (Medicine), Professor
Russian Federation, Moscow; MoscowLilia A. Moseykina
The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute
Email: surdolog@bk.ru
ORCID iD: 0000-0003-1961-7230
SPIN-code: 3249-5200
MD, Cand. Sci. (Medicine)
Russian Federation, MoscowKonstantin S. Bavin
The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute
Email: c.s.bavin@gmail.com
ORCID iD: 0000-0001-6659-5893
SPIN-code: 3635-6843
Russian Federation, Moscow
Maria A. Chugunova
The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute
Email: chugunova-la@mail.ru
ORCID iD: 0000-0002-4632-7901
SPIN-code: 8583-0848
MD, Cand. Sci. (Medicine)
Russian Federation, MoscowMaria A. Pryahina
The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute
Author for correspondence.
Email: mara.pryahina@gmail.com
ORCID iD: 0000-0003-3673-7410
SPIN-code: 3057-6356
MD, Cand. Sci. (Medicine)
Russian Federation, MoscowNaima N. Baytemirova
The Russian National Research Medical University named after N.I. Pirogov
Email: baitemirovanaima@yandex.ru
ORCID iD: 0000-0002-2262-1217
SPIN-code: 6276-1549
Russian Federation, Moscow
References
- Baylan MY, Yılmaz Ü, Akkuş Z, Topçu İ. Assessment of bone conduction thresholds after surgical treatment in patients with labyrinthine fistula. Turk Arch Otorhinolaryngol. 2018;56(2):89–94. doi: 10.5152/tao.2018.3238
- Quaranta N, Liuzzi C, Zizzi S, et al. Surgical treatment of labyrinthine fistula in cholesteatoma surgery. Otolaryngol Head Neck Surg. 2009;140(3):406–411. doi: 10.1016/j.otohns.2008.11.028
- Ikeda R, Kobayashi T, Kawase T, et al. Risk factors for deterioration of bone conduction hearing in cases of labyrinthine fistula caused by middle ear cholesteatoma. Ann Otol Rhinol Laryngol. 2012;121(3):162–167. doi: 10.1177/000348941212100304
- Garov EV. Laser destruction of ear labyrinth receptors in peripheral cochleovestibular disorders [dissertation abstract]. Moscow; 2005. (In Russ.) EDN: ZQMRZT
- Sari M, Baglam T, Ozturk O, Batman C. Labyrinthine fistula secondary to cholesteatomatous chronic otitis media. Int Adv Otol. 2010;6(1):18–24.
- Vrabec JT. Imaging of labyrinthine fistula after repair with bone pate. Laryngoscope. 2018l;128(7):1643–1648. doi: 10.1002/lary.26709
- Zelikovich EI. Potentialities of temporal bone CT in the diagnosis of chronic purulent otitis media and its complications. Journal of Radiology and Nuclear Medicine. 2004;(1):15–22. (In Russ.) EDN: MPTUGR
- Cho Ch, Yang H, Aum J, et al. Preservation of post-operative bone conduction hearing after labyrinthine fistula repair in chronic otitis media with cholesreatoma: a review of 23 cases. Int Adv Otol. 2014;10(1):39–43. doi: 10.5152/iao.2014.008
- Copeland BJ, Buchman CA. Management of labyrinthine fistulae in chronic ear surgery. Am J Otolaryngol. 2003;24(1):51–60. doi: 10.1053/ajot.2003.10
- Lim J, Gangal A, Gluth MB. Surgery for cholesteatomatous labyrinthine fistula. Ann Otol Rhinol Laryngol. 2017;126(3):205–215. doi: 10.1177/0003489416683193
- Peng Q, Liu K, Wang M, et al. Post-operative vestibular and equilibrium evaluation in patients with cholesteatoma-induced labyrinthine fistulas. J Laryngol Otol. 2024;138(1):16–21. doi: 10.1017/S0022215123000671
- Stephenson MF, Saliba I. Prognostic indicators of hearing after complete resection of cholesteatoma causing a labyrinthine fistula. Eur Arch Otorhinolaryngol. 2011;268(12):1705–1711. doi: 10.1007/s00405-011-1545-7
- Garov EV, Antonian RG, Sheremet AS, Garova EE. The retrospective clinical study of labyrinthine fistula associated with chronic suppurative otitis media and their treatment. Russian Bulletin of Otorhinolaryngology. 2012;(5):20–26. (In Russ.) EDN: PJPVSB
- Kryukov AI, Kynelskaya NL, Garov EV, et al. Variants of treatment of the head direction at the festulars of the labirinth of inflammatory genesis. Russian Bulletin of Otorhinolaryngology. 2019;84(5):20–25. (In Russ.) EDN: FGEIIF doi: 10.17116/otorino20198405120
- Dornhoffer JL, Milewski C. Management of the open labyrinth. Otolaryngol Head Neck Surg. 1995;112(3):410–404. doi: 10.1016/S0194-59989570275-X
- Pryahina MA. Treatment options for patients with inflammatory labyrinthine fistula [dissertation]. Moscow, 2023. (In Russ.) EDN: UNHALT
- Jang CH, Jo SY, Cho YB. Matrix removal of labyrinthine fistulae by non-suction technique with intraoperative dexamethasone injection. Acta Otolaryngol. 2013;133(9):910–915. doi: 10.3109/00016489.2013.782105
- Tomasoni M, Arcuri M, Dohin I, et al. Presentation, management, and hearing outcomes of labyrinthine fistula secondary to cholesteatoma: a systematic review and meta-analysis. Otol Neurotol. 2022;43(10):e1058–e1068. doi: 10.1097/MAO.0000000000003716
- Kim H, Ha J, Yeou SH, et al. What is the most important factor to preserve hearing in lateral semicircular canal fistula surgeries, fistula size or bony structure? Eur Arch Otorhinolaryngol. 2023;280(10):4419–4425. doi: 10.1007/s00405-023-07958-2
- McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015;1(1):CD005397. doi: 10.1002/14651858.CD005397.pub4
Supplementary files
