Chronic otitis media with cholesteatoma: A retrospective observational study on the management of lateral semicircular canal fistulas

Labyrinthine fistulas are a common complication of cholesteatomatous chronic otitis media (COM), with the lateral semicircular canal (LSCC) being the most frequently affected site. This retrospective cohort study aims to evaluate the clinical management of cases with LSSC fistula secondary to cholesteatomatous COM in a tertiary care hospital and analyze the obtained results along with the literature. Between January 2009 and June 2024, patients who developed LSSC fistula due to cholesteatomatous COM and underwent surgical treatment at our center were retrospectively analyzed. The study evaluated patients' demographic data, presenting symptoms, radiological findings, preoperative and postoperative audiological assessments, surgical approaches applied, and postoperative follow-up processes. A total of 36 patients were included in the study. Of these, 21 (58.3%) were male and 15 (41.7%) were female, with a mean age of 49.2 years. Postoperatively, patients were followed up for a minimum of 4 weeks and a maximum of 1 year. LSCC fistulas were classified based on Durko labyrinthine fistula classification, revealing Type I in 31 cases (86%), Type II in 3 cases (8%), and Type III in 2 cases (6%). Canal wall-down mastoidectomy was performed in all patients, transtemporal in 33 (92%) and inside-out mastoidectomy in 3 patients (8%). In 11 patients (31%), the fistula was covered with a temporalis muscle fascia graft, whereas in 25 patients (69%), a combination of bone dust and temporalis fascia was used for repair. No cases of recurrent cholesteatoma were detected during postoperative follow-up. The bone conduction thresholds were preserved in all patients, highlighting the positive postoperative hearing outcomes and the potential for a successful recovery. LSCC fistula is a common complication in COM with cholesteatoma patients. Early diagnosis and complete, atraumatic removal of the cholesteatoma matrix with closure using temporalis fascia and/or bone dust is a safe and effective treatment approach.