Labyrinthine fistula secondary to cholesteatoma
Labyrinthine fistula is a bony labyrinth defect of the petrous portion of the temporal bone. The membranous labyrinth can also be involved. المراهنات الرياضية
A 35-year-old male who underwent tympanoplasty and canal wall down mastoidectomy, presented in the ER with severe right sided otalgia, mastoid pain associated with otorrhea, debilitating vertigo and pulsatile tinnitus 13 years after the surgery. The symptoms had been present for six weeksUpon clinical examination, unsteady gait, Rhomberg’s positive sign and positive fistula were seen. No signs of meningism were seen and his facial nerve was also intact.
Further examination revealed signs of postauricular cellulitis and mixed hearing loss indication, through pure tone audiogram.
MRI confirmed the diagnosis of recurrent cholesteatoma
The patient was started on intravenous antibiotic and CT imaging was arranged. The CT scan identified a large and recurrent cholesteatoma. It was filling the right mastoidectomy cavity. A lateral semicircular canal fistula and erosion of the tegmen were also seen.
MRI confirmed the diagnosis of recurrent cholesteatoma, which was approximately 1.5cmx2c in the transverse and anteroposterior dimension. There was erosion of tegmen mastoideum and the dura overlying this region was elevated as a result of contiguous tegmen tympani.
The lateral genu of the semicircular canal was approximated by cholesteatoma. Furthermore, it had eroded parts of the tympanic and mastoid segments of the facial canal.
The patient was listed for right revision mastoidectomy with obliteration, three weeks after. لعبة بينجو اون لاين The findings included were loss of the posterior wall of the canal with a large cavity filled with keratin. In addition, after the removal of the cholesteatoma and necrotic bone, reconstruction of the defect was done through temporalis fascia and autologous bone graft. مواقع تربح منها المال
There was a gradual reduction of dizziness postoperatively, which took four months to resolve completely. His otorrhea and ear pain were resolved completely with improvement in hearing. He was asked to come for regular follow ups and remained well clinically after the procedure.
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