Surgical decision-making in cholesteatoma-induced labyrinthine fistula: hearing outcomes in a tertiary referral center.

objectiveTo evaluate surgical outcomes in patients with cholesteatoma-induced labyrinthine fistula, with particular emphasis on hearing preservation across different fistula stages and in selected cases requiring partial labyrinthectomy.

methodsA retrospective analysis was conducted on patients who underwent surgery for cholesteatoma with intraoperatively confirmed labyrinthine fistula at a tertiary referral center. Demographic data, clinical findings, radiological characteristics, fistula localization, size, and stage were recorded. Fistulae were classified according to the Dornhoffer-Milewski system. Surgical management was individualized according to fistula stage and intraoperative findings. Preoperative and 6-month postoperative bone-conduction (BC) thresholds were compared to assess audiological outcomes. Fistula size was measured on preoperative high-resolution computed tomography, and its relationship with postoperative hearing outcomes was analyzed.

resultsAmong 230 patients operated on for cholesteatoma, 39 (17.0%) had a labyrinthine fistula. The lateral semicircular canal was the most frequently involved site (84.6%). According to fistula stage, 17.9% were grade I, 53.8% grade II, and 28.2% grade III. Overall, mean BC thresholds showed no statistically significant change at 6 months postoperatively (p = 0.176). Hearing outcomes remained stable in grade I and grade II fistulae, whereas grade III fistulae demonstrated heterogeneous audiological outcomes, with a trend toward postoperative deterioration overall and slight improvement in selected patients managed without partial labyrinthectomy, without reaching statistical significance. Partial labyrinthectomy was performed in five patients with extensive grade III fistulae; although postoperative BC thresholds increased, residual hearing was preserved in all cases and no patient progressed to complete anacusis. Transient postoperative vestibular symptoms resolved with conservative management, and no patient developed persistent disabling vertigo.

conclusionSurgical management of cholesteatoma-induced labyrinthine fistula enables effective disease control with acceptable functional outcomes. Hearing preservation is generally achievable in early-stage fistulae, and even in selected advanced cases requiring partial labyrinthectomy, the applied surgical approach may allow preservation of residual hearing. These findings support an individualized, experience-based surgical approach guided by fistula characteristics and intraoperative assessment rather than fistula stage alone.