Does cholesteatoma matrix removal impair hearing in patients with low-grade labyrinthine fistulas?

Objective: To evaluate the functional outcomes of labyrinthine fistula treatment when the cholesteatoma matrix is totally removed and the defect is sealed with temporalis fascia during the same procedure. Materials and methods: Records of 188 patients who underwent middle ear surgery for chronic otitis media with cholesteatoma between June 2008-June 2014 in a tertiary referral center were retrospectively reviewed. Incidence of labyrinthine fistula, preoperative findings, types of surgery, intraoperative findings and postoperative functional outcomes were analyzed. Results: Incidence of labyrinth fistula was 17% (n=32). Lateral semicircular canal (LSSC) was the most frequent site for the fistula (90.6%). Thirty-two patients (10 females, 22 males) suffered this complication. Twenty-one patients underwent Canal Wall Down (CWD) Mastoidectomy without tympanoplasty and 11 patients underwent CWD Mastoidectomy + myringo-stapediopexy. Cholesteatoma matrix was removed and the defect was sealed with temporalis fascia (without using any other sealing material) in all cases. Bone conduction (BC) hearing level improved or remained unchanged in 24 patients; whereas eight patients out of 32 (25%) had a decrease in BC levels. In five (15.6%) of these patients, the impairment was more than 10 dB. None of the patients suffered total hearing loss preoperatively or postoperatively Conclusions: Removing the cholesteatoma matrix from the fistula site and covering the defect with temporalis fascia is a safe procedure in cases with labyrinthine fistulas. Temporalis fascia is a safe, economical and ‘easy to harvest’ sealing material that can be used alone especially for Type I and II fistulas.