Complications associated with labyrinthine fistula in surgery for chronic otitis media

OBJECTIVE: Labyrinthine fistula (LF) is encountered during surgery for chro nic otitis media (COM) with an average frequency of 7.5%. This study was un dertaken to investigate the prevalence of coexisting complications with LF in surgery for COM. STUDY DESIGN AND SETTING: A retrospective review of 111 consecutive cases o f COM surgery performed by the same surgeon in a targe metropolitan teachin g public hospital in the United States serving the inner city population. RESULTS: There were 23 (21%) LFs in 111 patients. The majority of cases wer e revision surgery with an average of 2.6 operations per patient. Other com plications were encountered in 18 (78%) of the 23 patients with an LF: 5 (2 2%) encephaloceles, 9 (39%) dehiscences of the tegmen, 12 (52%) patients wi th facial nerve involvement by cholesteatoma, and 2 (8.7%) patients with fa cial nerve paralysis. These patients required extensive surgery for correct ion of their concurrent complications. CONCLUSION: Compared with those cases in which a fistula was not found, the ratio of the above complications were as follows: encephalocele, 1:9; faci al nerve involvement by cholesteatoma, 1:11.3; facial nerve paralysis, 1:3. 8. SIGNIFICANCE: 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 obse rved in noncomplicated COM cases.