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What is the best method of treatment for labyrinthine fistulae caused by cholesteatoma?

A series of 19 patients with a labyrinthine fistula caused by cholesteatoma was analysed. Two patients presented with acute suppurative labyrinthitis and meningitis. A canal wall down procedure was performed in all but one patient. Of the 17 patients with preserved inner-ear function, the cholesteatoma matrix over the fistula was removed in 10 resulting in severe sensorineural hearing loss in one of these. The matrix was left in situ in 7 patients and hearing was maintained or improved in all of them. Post-operatively, 2 patients suffered from vestibular disturbances, the matrix covering the fistula being removed in both of them. It was concluded that preservation of the matrix over the fistula is the safest method of management of this serious complication of cholesteatomatous chronic ear disease.