Principles of safe surgery in patients with chronic suppurative otitis media complicated by labyrinthine fistula

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.