Prognostic indicators of hearing after complete resection of cholesteatoma causing a labyrinthine Wstula

The objectives of this study are (1) to evaluate hearing change after complete cholesteatoma resection in the setting of a labyrinthine Wstula, (2) to assess the sensitivity and speciWcity of the preoperative CT-scan in diagnosing a labyrinthine Wstula, and (3) to determine the correlation between the type of the labyrinthine Wstula and its radiologic size. A retrospective chart review of all patients operated for cholesteatoma between 2004 and 2009 was conducted. Primary outcome was deWned as the average variation in bone conduction thresholds (BCTs) as well as speech discrimination score (SDS) after total excision of cholesteatoma causing a labyrinthine Wstula. We reviewed all preoperative CT-scans and operative notes to assess sensitivity and speciWcity for the diagnosis of a labyrinthine Wstula. Results show that 317 patients underwent mastoidectomy for cholesteatoma. Twenty-eight patients were found to have 32 labyrinthine Wstulas caused by cholesteatomatous disease aVecting the lateral semi-circular canal (SCC) (n = 25), the superior SCC (n = 5), the posterior SCC (n = 1) and the footplate (n = 1). Postoperative BCT and SDS (24.5 dB; 86.6%) were neither clinically nor statistically diVerent from preoperative levels (23.2 dB; 87.5%) (p = 0.35). Sensitivity and speciWcity of the preoperative high resolution 0.55 mm cuts CT-scan was 100%. With a Wstula of 3.55 mm in the axial plan, a membraneous Wstula must be suspected with a sensitivity of 66% and a speciWcity of 71%. Complete matrix resection without suctioning at the site of a cholesteatomatous labyrinthine Wstula is a safe and eVective management option. High-resolution preoperative CT-scan is very precise in diagnosing labyrinthine Wstula and its radiologic size helps to predict the type of the Wstula.