Surgical management of labyrinthine fistulae in chronic otitis media with cholesteatoma by a one-stage closed technique.

Twenty cases of labyrinthine fistulae have been reviewed. From 1979 to 1987, 234 patients with cholesteatomatous ears were operated on by one surgeon, 20 of these had a labyrinthine fistula (incidence 8.6%). In 75% only the lateral semicircular canal was involved and in 25% the other semicircular canals and/or the cochlea were involved. The fistula test was positive in 50% of the cases. The surgical technique used in all 20 cases was a one-stage closed tympanoplasty, i.e. removal of the cholesteatoma matrix, covering of the fistula with fascia and bone, obliteration of the cavity and reconstruction of the meatal wall. 76% of the patients achieved a hearing improvement, while 1 patient had anacusis (5%). The results indicate that it is possible in one stage to remove the cholesteatoma matrix from the fistula and still be able to restore useful hearing in the majority of the patients.