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Treatment of Labyrinthine Fistula With Interruption of the Semicircular Canals

Treatment of Labyrinthine Fistula With Interruption of the Semicircular Canals Abstract Evaluation of postoperative hearing acuity and equilibrium was performed in eight patients with labyrinthine fistula caused by cholesteatoma, in which at least one of the semicircular canals (five cases, lateral; one case, superior; one case, posterior; and one case, both lateral and superior) was interrupted during eradication of the matrix and granulations from the semicircular canals. The interrupted semicircular canals were obliterated firmly with autologous materials such as fascia, perichondrium, bone chips, and cartilage. The observation period ranged from 9 months to 3.3 years. Postoperative hearing was unaltered or improved in seven patients, and decreased by 12 dB in one patient. Postoperative disequilibrium lasting more than 2 weeks was experienced in two patients and disappeared at the second and fifth postoperative months, respectively. Relief from fistula symptoms was complete after surgery, indicating adequacy of this procedure in one-stage open-method tympanoplasty. The present study indicates that manipulation of the semicircular canal with awareness can be conducted without damaging the cochlear function, and that the treatment of labyrinthine fistulas should be performed very carefully but not so conservatively as to lead to future problems. In some cases of deep fistulas of the semicircular canals, interruption and/or obliteration of the semicircular canals can be the most proper procedure. (Arch Otolaryngol Head Neck Surg. 1995;121:469-475) References 1. Sheehy JL, Brackmann DE. Cholesteatoma surgery: management of the labyrinthine fistula—report of 97 cases . Laryngoscope . 1979;89:78-87.Crossref 2. Wayoff MR, Friot JM. Analysis of 100 cases of fistulas of the external semicircular canal . In: McCabe BF, Sade J, Abramson M, eds. Cholesteatoma First International Conference . New York, NY: Aesculapius Publishers Inc; 1977:463-464. 3. Sanna M, Zini C, Bacciu S, Scandellari R, Delogu P, Jemmi G. Management of the labyrinthine fistula in cholesteatoma surgery . ORL J Otorhinolaryngol Relat Spec . 1984;46:165-172.Crossref 4. McCabe BF. Labyrinthine fistula in chronic mastoiditis . Ann Otol Rhinol Laryngol . 1984;93 ( (suppl 112) ):138-141. 5. Kobayashi T, Sakurai T, Okitsu T, et al. Labyrinthine fistulae caused by cholesteatoma: improved bone conduction by treatment . Am J Otol . 1989;10:5-10. 6. Kobayashi T, Shiga N, Hozawa K, Hashimoto S, Takasaka T. Effect on cochlear potentials of lateral semicircular canal destruction . Arch Otolaryngol Head Neck Surg . 1991;117:1292-1295.Crossref 7. Phelps PD. Preservation of hearing in the labyrinth invaded by cholesteatoma . J Laryngol Otol . 1969;83:1111-1114.Crossref 8. Bumsted RM, Sade J, Dolan KD, McCabe BF. Preservation of cochlear function after extensive labyrinthine destruction . Ann Otol Rhinol Laryngol . 1977;86:131-137. 9. Jahrsdoerfer RA, Johns ME, Cantrell RW. Labyrinthine trauma during ear surgery . Laryngoscope . 1978;88:1589-1595.Crossref 10. Thomsen J, Barford C, Fleckenstein P. Congenital cholesteatoma: preservation of cochlear function after extensive labyrinthine destruction . J Laryngol Otol . 1980;94:263-268.Crossref 11. Palva T, Johanson LG. Preservation of hearing after removal of the membranous canal with a cholesteatoma . Arch Otolaryngol Head Neck Surg . 1986;112:982-985.Crossref 12. Palva T, Ramsay H. Treatment of labyrinthine fistula . Arch Otolaryngol Head Neck Surg . 1989; 115:804-806.Crossref 13. Parnes LS, McClure AJ. Effect on brainstem auditory evoked responses of posterior semicircular canal occlusion in guinea pigs . J Otolaryngol . 1985;14:145-150. 14. Gjuric M, Wigand ME, Hosemann W, Berg M. Selektive Resektion des lateralen Bogengangs mit Gehorehaltung-ein tierexperimentelle Studie . HNO . 1991;39:476-481. 15. Money KE, Scott JW. Functions of separate sensory receptors of nonauditory labyrinth of the cat . Am J Physiol . 1962;202:1211-1220. 16. Parnes LS, McClure AJ. Posterior semicircular canal occlusion in the normal hearing ear . Otolaryngol Head Neck Surg . 1991;104:52-57. 17. Pace-Balzan A, Rutka JA. Non-ampullary plugging of the posterior semicircular canal for benign paroxysmal positional vertigo . J Laryngol Otol . 1991;105:901-906.Crossref 18. Anthony PF. Partitioning of the labyrinth: application in benign paroxysmal positional vertigo . Am J Otol . 1991;12:388-393. 19. Lim DJ. Scanning electron microscopic morphology of the ear . In: Paparella MM, Shmurick DA, eds. Otolaryngology . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1980;1:444-446. 20. Arai Y, Henn V, Boehmer A, Suzuki J. How could canal-pluggings result in intensive direction changing type of positional nystagmus? Acta Otolaryngol . 1989; (suppl) 468:159-164.Crossref 21. Scherer H, Clarke AH. The caloric vestibular reaction in space: physiological considerations . Acta Otolaryngol . 1985;100:328-336.Crossref 22. Harada Y, Ariki T, Suzuki M. A new theory on thermal endolymphatic flow . In: Graham MD, Kemink JL, eds. The Vestibular System: Neurophysiologic and Clinical Research . New York, NY: Raven Press; 1987:107-114. 23. Paige G. Caloric vestibular responses despite canal inactivation . Invest Ophthalmol Vis Sci . 1984; 25( (suppl) ):229. 24. Zenner HP, Zimmermann U. Motile responses of vestibular hair cells following caloric, electrical or chemical stimuli . Acta Otolaryngol . 1991; 111:291-297.Crossref 25. Arai Y, Suzuki J-I, Hess BJM, Henn V. Caloric nystagmus in three dimensions under otolithic control in rhesus monkeys: a preliminary report . ORL J Otorhinolaryngol Relat Spec . 1990; 52:218-225.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1995.01890040087015
Publisher site
See Article on Publisher Site

Abstract

Abstract Evaluation of postoperative hearing acuity and equilibrium was performed in eight patients with labyrinthine fistula caused by cholesteatoma, in which at least one of the semicircular canals (five cases, lateral; one case, superior; one case, posterior; and one case, both lateral and superior) was interrupted during eradication of the matrix and granulations from the semicircular canals. The interrupted semicircular canals were obliterated firmly with autologous materials such as fascia, perichondrium, bone chips, and cartilage. The observation period ranged from 9 months to 3.3 years. Postoperative hearing was unaltered or improved in seven patients, and decreased by 12 dB in one patient. Postoperative disequilibrium lasting more than 2 weeks was experienced in two patients and disappeared at the second and fifth postoperative months, respectively. Relief from fistula symptoms was complete after surgery, indicating adequacy of this procedure in one-stage open-method tympanoplasty. The present study indicates that manipulation of the semicircular canal with awareness can be conducted without damaging the cochlear function, and that the treatment of labyrinthine fistulas should be performed very carefully but not so conservatively as to lead to future problems. In some cases of deep fistulas of the semicircular canals, interruption and/or obliteration of the semicircular canals can be the most proper procedure. (Arch Otolaryngol Head Neck Surg. 1995;121:469-475) References 1. Sheehy JL, Brackmann DE. Cholesteatoma surgery: management of the labyrinthine fistula—report of 97 cases . Laryngoscope . 1979;89:78-87.Crossref 2. Wayoff MR, Friot JM. Analysis of 100 cases of fistulas of the external semicircular canal . In: McCabe BF, Sade J, Abramson M, eds. Cholesteatoma First International Conference . New York, NY: Aesculapius Publishers Inc; 1977:463-464. 3. Sanna M, Zini C, Bacciu S, Scandellari R, Delogu P, Jemmi G. Management of the labyrinthine fistula in cholesteatoma surgery . ORL J Otorhinolaryngol Relat Spec . 1984;46:165-172.Crossref 4. McCabe BF. Labyrinthine fistula in chronic mastoiditis . Ann Otol Rhinol Laryngol . 1984;93 ( (suppl 112) ):138-141. 5. Kobayashi T, Sakurai T, Okitsu T, et al. Labyrinthine fistulae caused by cholesteatoma: improved bone conduction by treatment . Am J Otol . 1989;10:5-10. 6. Kobayashi T, Shiga N, Hozawa K, Hashimoto S, Takasaka T. Effect on cochlear potentials of lateral semicircular canal destruction . Arch Otolaryngol Head Neck Surg . 1991;117:1292-1295.Crossref 7. Phelps PD. Preservation of hearing in the labyrinth invaded by cholesteatoma . J Laryngol Otol . 1969;83:1111-1114.Crossref 8. Bumsted RM, Sade J, Dolan KD, McCabe BF. Preservation of cochlear function after extensive labyrinthine destruction . Ann Otol Rhinol Laryngol . 1977;86:131-137. 9. Jahrsdoerfer RA, Johns ME, Cantrell RW. Labyrinthine trauma during ear surgery . Laryngoscope . 1978;88:1589-1595.Crossref 10. Thomsen J, Barford C, Fleckenstein P. Congenital cholesteatoma: preservation of cochlear function after extensive labyrinthine destruction . J Laryngol Otol . 1980;94:263-268.Crossref 11. Palva T, Johanson LG. Preservation of hearing after removal of the membranous canal with a cholesteatoma . Arch Otolaryngol Head Neck Surg . 1986;112:982-985.Crossref 12. Palva T, Ramsay H. Treatment of labyrinthine fistula . Arch Otolaryngol Head Neck Surg . 1989; 115:804-806.Crossref 13. Parnes LS, McClure AJ. Effect on brainstem auditory evoked responses of posterior semicircular canal occlusion in guinea pigs . J Otolaryngol . 1985;14:145-150. 14. Gjuric M, Wigand ME, Hosemann W, Berg M. Selektive Resektion des lateralen Bogengangs mit Gehorehaltung-ein tierexperimentelle Studie . HNO . 1991;39:476-481. 15. Money KE, Scott JW. Functions of separate sensory receptors of nonauditory labyrinth of the cat . Am J Physiol . 1962;202:1211-1220. 16. Parnes LS, McClure AJ. Posterior semicircular canal occlusion in the normal hearing ear . Otolaryngol Head Neck Surg . 1991;104:52-57. 17. Pace-Balzan A, Rutka JA. Non-ampullary plugging of the posterior semicircular canal for benign paroxysmal positional vertigo . J Laryngol Otol . 1991;105:901-906.Crossref 18. Anthony PF. Partitioning of the labyrinth: application in benign paroxysmal positional vertigo . Am J Otol . 1991;12:388-393. 19. Lim DJ. Scanning electron microscopic morphology of the ear . In: Paparella MM, Shmurick DA, eds. Otolaryngology . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1980;1:444-446. 20. Arai Y, Henn V, Boehmer A, Suzuki J. How could canal-pluggings result in intensive direction changing type of positional nystagmus? Acta Otolaryngol . 1989; (suppl) 468:159-164.Crossref 21. Scherer H, Clarke AH. The caloric vestibular reaction in space: physiological considerations . Acta Otolaryngol . 1985;100:328-336.Crossref 22. Harada Y, Ariki T, Suzuki M. A new theory on thermal endolymphatic flow . In: Graham MD, Kemink JL, eds. The Vestibular System: Neurophysiologic and Clinical Research . New York, NY: Raven Press; 1987:107-114. 23. Paige G. Caloric vestibular responses despite canal inactivation . Invest Ophthalmol Vis Sci . 1984; 25( (suppl) ):229. 24. Zenner HP, Zimmermann U. Motile responses of vestibular hair cells following caloric, electrical or chemical stimuli . Acta Otolaryngol . 1991; 111:291-297.Crossref 25. Arai Y, Suzuki J-I, Hess BJM, Henn V. Caloric nystagmus in three dimensions under otolithic control in rhesus monkeys: a preliminary report . ORL J Otorhinolaryngol Relat Spec . 1990; 52:218-225.Crossref

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Apr 1, 1995

References

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