Underwater endoscopic ear surgery for repair of lateral semicircular canal fistulae secondary to cholesteatoma: a pilot safety analysis

Ruyan Chen*, Corinne P. A. Delsing, Alex Saxby, Jonathan H. K. Kong, Nicholas Jufas, Nirmal P. Patel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Underwater endoscopic repair of labyrinthine fistulae has the potential to improve visualisation and reduce the exposure of the membranous labyrinthine to air when removing disease. This work sought to undertake a safety and efficacy analysis of a novel method of underwater endoscopic ear surgery (UWEES), which can be used to repair cholesteatomatous labyrinthine fistulae. Methods: A retrospective review was conducted of 11 patients with high grade (Dornhoffer IIa or greater) labyrinthine fistula secondary to cholesteatoma operated on between 2015-2022. All patients had UWEES technique, resurfacing repair of fistulae using combinations of temporalis fascia, bone pate and/or composite cartilage. The primary outcome was pre- and post-operative bone conduction audiograms conducted at a mean of 18 months postoperatively [standard deviation (SD) 22] and secondary outcomes included subjective vertigo and recidivistic disease. Results: There was no significant difference in mean bone conduction thresholds pre- and post-operatively (Z=-0.664, P=0.51). Ten out of the eleven patients had a type II fistula (5 type IIa, 5 type IIb) and one had type III. There was no significant difference in mean hearing outcome between Dornhoffer type 2a and 2b fistulas. The patient with type 3 fistula had significant deterioration in hearing post-operatively. Only 1 patient (out of 9 patients with preoperative vertigo) had residual vertigo after 6 months. One patient (9%) had recurrent disease and one patient (9%) had residual disease at a mean follow up time of 34 months (SD 22). Conclusion: UWEES may be an effective method to preserve hearing. Longer follow up is required to assess recidivistic outcomes and full safety of the technique.

Original languageEnglish
Article number40
Pages (from-to)1-9
Number of pages9
JournalAustralian Journal of Otolaryngology
Volume7
DOIs
Publication statusPublished - 30 Nov 2024

Bibliographical note

Copyright AME Publishing Company, Australian Society of Otolaryngology Head & Neck Surgery. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • cholesteatoma
  • ear, middle/surgery
  • Endoscopy
  • labyrinthine fistula
  • treatment outcome

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