Labyrinthine fistula is defined as erosive loss of bone that lies over the labyrinth and it is almost exclusively seen as a complication of chronic otitis media with cholesteatoma. Sensorineural hearing loss and positional vertigo are typical symptoms and the diagnosis can be made by a thorough examination and imaging studies. Surgery is the main form of treatment.
The diagnosis may be difficult to attain due to striking similarities to BPPV and Meniere's disease, but in all patients who suffer from chronic otitis media and experience vestibulocochlear symptoms, a strong clinical suspicion must be present. A thorough patient history and a meticulous physical examination should be supported by audiology, vestibulometric studies, pressure test and CT of the temporal bone in order to differentiate between various clinical entities  .
Surgical treatment is the mainstay in these patients and current approaches include canal wall down mastoidectomy and either total or incomplete removal of cholesteatoma matrix  . Surgery may be avoided, however, when a significant risk for postoperative complications (hearing deterioration or even deafness) exists, more commonly in the setting of extensive fistulas  . For this reason, a careful preoperative evaluation is necessary to conclude what is the optimal therapeutic approach.
Several factors determine the outcome of labyrinthine fistula, including its size, location, severity of symptoms and experience of the surgeon , as hearing impairment may be a complication of treatment. Additionally, the type of fistula can determine the outcome - bony fistula affects only the bony labyrinth, while extensive fistula causes erosion of both bony and membranous labyrinths . For these reasons, early recognition and treatment are mandatory in reducing the risk of adverse events.
Labyrinthine fistula almost always stems as a complication of chronic otitis media with cholesteatoma   .
Labyrinthine fistulas are diagnosed in approximately 5-10% of patients who develop chronic otitis media with cholesteatoma , whereas others report a somewhat broader range - 3.6 to 13.9% . The median age of patients was described to be 50 years in isolated reports , but neither gender nor age predilections have been determined so far.
Presumably, the chronic inflammatory state in chronic otitis media and the expanding cholesteatoma cause progressive erosion and loss of endochondral bone that protects the vestibulocochlear system . When the bone barrier is breached, the leakage of perilymph from the inner ear into the middle ear occurs and disrupts the normal function of the labyrinth and tympanic membrane .
Early recognition of chronic otitis media and its treatment are by far the most important preventive strategies in reducing the risk of labyrinthine fistula development.
Labyrinthine fistula is a condition in which an abnormal connection between the perilymph-filled inner ear and air-filled middle ear exists, most likely as a complication of chronic otitis media with cholesteatoma  . The fistula is created due to erosive loss of bone overlying the labyrinth and leakage of perilymph into the middle ear, giving symptoms such as vertigo and sensorineural hearing loss  . About 5-10% of chronic otitis media with cholesteatoma patients develop a labyrinthine fistula and the most common location is the lateral semicircular canal  . The diagnosis mandates a thorough diagnostic workup, as the condition may mimic benign paroxysmal positional vertigo (BPPV) and Meniere's disease . Treatment principles rely on surgical correction of this inner ear pathology, with canal wall down mastoidectomy and removal of cholesteatoma matrix serving as possible approaches   . Complications such as deafness may arise post-operatively, however, which is why careful preoperative assessment by experienced surgeons is necessary to determine the optimal approach to labyrinthine fistula treatment.
Labyrinthine fistula is a condition in which chronic infection of the middle ear (otitis media) accompanied by cholesteatoma (an abnormal skin growth in the middle ear) creates a connection between the middle ear and the inner ear by destroying the bone overlying the inner ear. Damage to the labyrinth, the main structure of the inner ear, occurs as a result of these changes, causing leakage of perilymph from the inner ear into the middle ear, manifesting with symptoms such as dizziness and varying degrees of hearing loss. To make the diagnosis, it is necessary to perform a detailed physical examination and several tests to differentiate this condition from other that present with similar symptoms. Treatment requires surgical correction of the damage caused by chronic infection of the middle ear and cholesteatoma, but factors such as the size and location of the fistula and the severity of bone damage determine the optimal surgical strategy.