{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T05:01:18Z","timestamp":1778043678801,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Carol Davila University of Medicine and Pharmacy, Bucharest, Romania"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: To evaluate the surgical management and outcomes of lateral semicircular canal fistulas (LSCFs) in patients with middle ear cholesteatoma, focusing on hearing preservation and vestibular function. Materials and Methods: A retrospective study was conducted on nine adult patients diagnosed with LSCFs secondary to cholesteatoma who underwent surgery at a tertiary referral center between 2018 and 2024. The preoperative evaluation included otoscopy, audiometry, vestibular testing (HINTS), and high-resolution CT (HRCT) of the temporal bone. Surgical techniques included canal wall up (CWU) or canal wall down (CWD) mastoidectomy, depending on the disease extent. Cholesteatoma matrix removal from the fistula was performed carefully. Fistula closure involved layered grafts of temporalis fascia, temporalis muscle, and\/or gelfoam. The postoperative follow-up included audiometry and vestibular assessments. Results: Nine patients with LSCFs were identified (one Type III, three Type IIb, and four Type I\/IIa). Five patients were found to have additional disease complications intraoperatively, including facial nerve involvement and middle fossa dehiscence. Postoperatively, hearing outcomes varied, with some patients experiencing improvement, others demonstrating stable hearing, and some exhibiting further decline, particularly in cases with extensive disease. Vestibular symptoms, including vertigo, generally resolved postoperatively, although some patients required prolonged vestibular rehabilitation. Conclusions: LSCF management in cholesteatoma surgery requires a careful preoperative assessment, meticulous surgical technique, and individualized fistula closure based on the size and type. While hearing preservation remains a challenge, particularly in extensive cases, the \u201cunderwater technique\u201d and layered grafting may contribute to minimizing further damage and promoting fistula closure. Vestibular rehabilitation plays a crucial role in managing postoperative balance issues. A long-term follow-up is essential to monitor for recurrence and assess both auditory and vestibular function.<\/jats:p>","DOI":"10.3390\/medicina61122144","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T12:39:43Z","timestamp":1764679183000},"page":"2144","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intraoperative Management of Lateral Semicircular Canal Fistula in Cholesteatoma Surgery: Retrospective Case Series and Audiovestibular Follow-Up"],"prefix":"10.3390","volume":"61","author":[{"given":"Maria Denisa","family":"Zica","sequence":"first","affiliation":[{"name":"General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Institute of Phonoaudiology and Functional ENT Surgery \u201cProfesor Dr. D. Hociota\u201d, 050751 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catalina","family":"Voiosu","sequence":"additional","affiliation":[{"name":"General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Institute of Phonoaudiology and Functional ENT Surgery \u201cProfesor Dr. D. Hociota\u201d, 050751 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreea","family":"Rusescu","sequence":"additional","affiliation":[{"name":"General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Institute of Phonoaudiology and Functional ENT Surgery \u201cProfesor Dr. D. Hociota\u201d, 050751 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irina","family":"Ionita","sequence":"additional","affiliation":[{"name":"General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Institute of Phonoaudiology and Functional ENT Surgery \u201cProfesor Dr. D. Hociota\u201d, 050751 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5250-9219","authenticated-orcid":false,"given":"Luana Maria","family":"Gherasie","sequence":"additional","affiliation":[{"name":"General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oana Ruxandra","family":"Alius","sequence":"additional","affiliation":[{"name":"General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Institute of Phonoaudiology and Functional ENT Surgery \u201cProfesor Dr. D. Hociota\u201d, 050751 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Bizdu Branovici","sequence":"additional","affiliation":[{"name":"General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Razvan","family":"Hainarosie","sequence":"additional","affiliation":[{"name":"General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Institute of Phonoaudiology and Functional ENT Surgery \u201cProfesor Dr. D. Hociota\u201d, 050751 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viorel","family":"Zainea","sequence":"additional","affiliation":[{"name":"General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Institute of Phonoaudiology and Functional ENT Surgery \u201cProfesor Dr. D. Hociota\u201d, 050751 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.bjorl.2018.01.005","article-title":"Cholesteatoma labyrinthine fistula: Prevalence and impact","volume":"85","author":"Rosito","year":"2019","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"21","DOI":"10.4137\/CMENT.S10681","article-title":"Evaluation of temporal bone cholesteatoma and the correlation between high resolution computed tomography and surgical finding","volume":"6","author":"Gomaa","year":"2013","journal-title":"Clin. Med. Insights Ear Nose Throat"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/00034894740830S101","article-title":"The surgical management of labyrinthine fistulae in chronic otitis media with cholesteatoma","volume":"83","author":"Gacek","year":"1974","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1053\/ajot.2003.10","article-title":"Management of labyrinthine fistulae in chronic ear surgery","volume":"24","author":"Copeland","year":"2003","journal-title":"Am. J. Otolaryngol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5604\/00306657.1147030","article-title":"Postoperative bone conduction threshold changes in patients operated on for chronic otitis media\u2013analysis","volume":"69","author":"Wiatr","year":"2015","journal-title":"Otolaryngol. Pol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2616","DOI":"10.1002\/lary.24785","article-title":"Closure technique for labyrinthine fistula by \u201cunderwater\u201d endoscopic ear surgery","volume":"124","author":"Yamauchi","year":"2014","journal-title":"Laryngoscope"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/s12070-022-03208-9","article-title":"Labyrinthine Fistula in Chronic Otitis Media Surgery: Management and Outcomes","volume":"75","author":"Castro","year":"2023","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Aw, N.M.Y., Thong, J.F., Tan, B.Y.B., and Tan, V.Y.J. (Singap. Med. J., 2023). Managing cholesteatomas with labyrinthine fistula, Singap. Med. J., ahead of print.","DOI":"10.4103\/singaporemedj.SMJ-2021-377"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1007\/s00405-021-06934-y","article-title":"\u201cSandwich technique\u201d enables preservation of hearing and antivertiginous effect in cholesteatomatous labyrinthine fistula","volume":"279","author":"Bartochowska","year":"2022","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3355","DOI":"10.1007\/s00405-021-07058-z","article-title":"Post-operative hearing among patients with labyrinthine fistula as a complication of cholesteatoma using \u201cunder water technique\u201d","volume":"279","author":"Thangavelu","year":"2022","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21037\/ajo-24-3","article-title":"Underwater endoscopic ear surgery for repair of lateral semicircular canal fistulae secondary to cholesteatoma\u2014A pilot safety analysis","volume":"7","author":"Chen","year":"2024","journal-title":"Aust. J. Otolaryngol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"8","DOI":"10.3109\/00016489.2015.1087650","article-title":"A retrospective study on post-operative hearing of middle ear cholesteatoma patients with labyrinthine fistula","volume":"136","author":"Yue","year":"2016","journal-title":"Acta Otolaryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/S0194-59989570275-X","article-title":"Management of the open labyrinth","volume":"112","author":"Dornhoffer","year":"1995","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e1691","DOI":"10.1097\/MAO.0000000000003238","article-title":"Hearing outcomes for an underwater endoscopic technique for transmastoid repair of superior semicircular canal dehiscence","volume":"42","author":"Creighton","year":"2021","journal-title":"Otol. Neurotol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"888s","DOI":"10.1177\/01455613211040580","article-title":"Cholesteatoma causing a horizontal semicircular canal fistula","volume":"100","author":"Djalilian","year":"2021","journal-title":"Ear Nose Throat J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3605","DOI":"10.1007\/s00405-017-4697-2","article-title":"Management of labyrinthine fistula: Hearing preservation versus prevention of residual disease","volume":"274","author":"Geerse","year":"2017","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1017\/S0022215119002032","article-title":"Gauging the effectiveness of canal occlusion surgery: How I do it","volume":"133","author":"Hassannia","year":"2019","journal-title":"J. Laryngol. Otol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2055","DOI":"10.1007\/s00405-015-3775-6","article-title":"Lateral semicircular canal fistula in cholesteatoma: Diagnosis and management","volume":"273","author":"Meyer","year":"2016","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Jiang, Y., Xu, M., Yao, Q., Li, Z., Wu, Y., Chen, Z., Yu, D., Shi, H., and Yin, S. (2022). Changes of vestibular symptoms in meni\u00e8re\u2019s disease after triple semicircular canal occlusion: A long-term follow-up study. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.797699"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/MAO.0000000000003461","article-title":"Hearing outcomes of transmastoid plugging for superior canal dehiscence syndrome by underwater endoscopic surgery: With special reference to transient bone conduction increase in early postoperative period","volume":"43","author":"Kawamura","year":"2022","journal-title":"Otol. Neurotol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1017\/S002221512100387X","article-title":"Triple semicircular canal occlusion: A surgical perspective with short- and long-term outcomes","volume":"136","author":"Kontorinis","year":"2022","journal-title":"J. Laryngol. Otol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e532","DOI":"10.1097\/MAO.0000000000002205","article-title":"Different materials for plugging a dehiscent superior semicircular canal: A comparative histologic study using a gerbil model","volume":"40","author":"Kwok","year":"2019","journal-title":"Otol. Neurotol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1177\/0003489416683193","article-title":"Surgery for cholesteatomatous labyrinthine fistula","volume":"126","author":"Lim","year":"2017","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1097\/01.mlg.0000157844.48036.e7","article-title":"Operative management of superior semicircular canal dehiscence","volume":"115","author":"Mikulec","year":"2005","journal-title":"Laryngoscope"},{"key":"ref_25","first-page":"167","article-title":"Labyrinthine fistulae in squamosal type of chronic otitis media: Therapeutic outcome","volume":"31","author":"Misale","year":"2019","journal-title":"Iran. J. Otorhinolaryngol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1007\/s00701-017-3346-2","article-title":"Middle cranial fossa approach for the repair of superior semicircular canal dehiscence is associated with greater symptom resolution compared to transmastoid approach","volume":"160","author":"Nguyen","year":"2018","journal-title":"Acta Neurochir."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Ossen, M.E., Stokroos, R., Kingma, H., van Tongeren, J., Van Rompaey, V., Temel, Y., and van de Berg, R. (2017). Heterogeneity in reported outcome measures after surgery in superior canal dehiscence syndrome-a systematic literature review. Front. Neurol., 8.","DOI":"10.3389\/fneur.2017.00347"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.otohns.2008.11.028","article-title":"Surgical treatment of labyrinthine fistula in cholesteatoma surgery","volume":"140","author":"Quaranta","year":"2009","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1177\/0003489418755407","article-title":"One-stage complete resection of cholesteatoma with labyrinthine fistula: Hearing changes and clinical outcomes","volume":"127","author":"Rah","year":"2018","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Committeri, U., Monarchi, G., Gilli, M., Caso, A.R., Sacchi, F., Abbate, V., Troise, S., Consorti, G., Giovacchini, F., and Mitro, V. (2025). Artificial Intelligence in the Surgery-First Approach: Harnessing Deep Learning for Enhanced Condylar Reshaping Analysis: A Retrospective Study. Life, 15.","DOI":"10.3390\/life15020134"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5229","DOI":"10.1007\/s00415-021-10693-5","article-title":"The resilience of the inner ear-vestibular and audiometric impact of transmastoid semicircular canal plugging","volume":"269","author":"Stultiens","year":"2022","journal-title":"J. Neurol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/MAO.0000000000001277","article-title":"A comparison of surgical treatments for superior semicircular canal dehiscence: A systematic review","volume":"38","author":"Ziylan","year":"2017","journal-title":"Otol. Neurotol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/12\/2144\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T13:19:21Z","timestamp":1764681561000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/12\/2144"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,30]]},"references-count":32,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["medicina61122144"],"URL":"https:\/\/doi.org\/10.3390\/medicina61122144","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,30]]}}}