Complications associated with labyrinthine fistula in surgery for chronic otitis media.

Abstract

Labyrinthine fistula (LF) is encountered during surgery for chronic otitis media (COM) with an average frequency of 7.5%. This study was undertaken to investigate the prevalence of coexisting complications with LF in surgery for COM. A retrospective review of 111 consecutive cases of COM surgery performed by the same surgeon in a large metropolitan teaching public hospital in the United States serving the inner city population. There were 23 (21%) LFs in 111 patients. The majority of cases were revision surgery with an average of 2.6 operations per patient. Other complications were encountered in 18 (78%) of the 23 patients with an LF: 5 (22%) encephaloceles, 9 (39%) dehiscences of the tegmen, 12 (52%) patients with facial nerve involvement by cholesteatoma, and 2 (8.7%) patients with facial nerve paralysis. These patients required extensive surgery for correction of their concurrent complications. Compared with those cases in which a fistula was not found, the ratio of the above complications were as follows: encephalocele, 1:9; facial nerve involvement by cholesteatoma, 1:11.3; facial nerve paralysis, 1:3.8. Patients with neglected COM have an incidence of an LF twice that reported in the literature. The prevalence of associated complications with LF requiring extensive surgery is significantly higher than that observed in noncomplicated COM cases.