"Underwater" Technique: Auditory Vestibular and Facial Nerve Preservation

Labyrinthine fistula (LF) is a pathological condition with abnormal communication between the inner ear and the middle/mastoid cavity. LF usually depends on cholesteatoma and may cause hearing loss, dizziness, and facial palsy.

Surgical management is the treatment of choice since hearing preservation and the technique to perform are a source of debate.

Some authors retain the cholesteatoma matrix on the side of LF to avoid damage to cochlear function. The other management claims to totally remove cholesteatoma, repairing the labyrinth with bone sealing. In cases of cholesteatoma matrix removal, the fistula is commonly covered without suctioning and without drilling the bone labyrinth to reduce the risk of hearing.

In 2008, Magliulo et al. proposed a partial labyrinthectomy as a safe technique to treat LF with hearing preservation, performing the total removal of the cholesteatoma matrix and involving bone cover. This procedure may also be used in petrous bone cholesteatoma to preserve the labyrinth's anatomic structure and functional activity. The results showed a high rate of hearing preservation in both cases, which was also proved by radiological imaging. Therefore, the strength of this technique lies in the respect of the inner ear's anatomic structure and functional activity.