Management of labyrinthine fistula using Surdille flap


  • Rashmi P. Rajashekhar Department of ENT, Dr D. Y. Patil Medical College, Pune, Maharashtra, India
  • Vinod V. Shinde Department of ENT, Dr D. Y. Patil Medical College, Pune, Maharashtra, India



Surdille flap, Labyrinthine fistula, Cholesteatoma, Mastoidectomy


Background: Labyrinthine fistula (LF) is the most common intra-temporal complication of squamosal chronic otitis media represents an erosive loss of endochondral bone overlying the semicircular canals without loss of perilymph. Main treatment of LF is surgical. The aim of our study is to discuss its incidence and sex ratio. The main objective is to describe the audio-vestibular results after closure of labyrinthine fistula by our technique using surdille flap.

Methods: 234 patients with squamosal chronic otitis media presented to our institution in a period of 24 months. Out of 234 patients, 22 patients were having labyrinthine fistula. Eleven patients had fistula test positive. Rest eleven patients were found to have LF intra-operatively. All patients underwent canal wall down modified radical mastoidectomy (MRM). Treatment of LF was done surgically by using surdille flap in all the cases. Post operatively Audio-vestibular results of labyrinthine fistula surgery by our technique were studied.  

Results: The results show that the cholesteatoma matrix can be removed from the fistula. Removal of the fistula generally improves the vestibular symptoms. In all patients canal wall down procedure was done with surdille flap seal over LF. In our study, incidence of LF was 9.40% and none of the patients ended up with postoperative deafness. Hearing improved in 36.40% patients whereas it remained unchanged in rest of the cases.

Conclusions: Labyrinthine fistula, very commonly seen in the lateral semicircular canal has incidence of 5-10% reported in many studies. We demonstrated that open technique with removal of matrix and sealing with three layers may be a valuable choice for the surgical treatment of LF with little risk for cochlea-vestibular functions. Advantage of using surdille flap (sealing the fistula with three layers) is that it decreases the possibility of postoperative vertigo.

Author Biography

Rashmi P. Rajashekhar, Department of ENT, Dr D. Y. Patil Medical College, Pune, Maharashtra, India

Dept of otorhinolaryngology

Asst. Professor


Glasscock-Shambaugh. Surgery of the ear. 5th Ed. In: Gross ND, McMenomey SO, eds. 2003: 438-439.

Ludman H. Complications of suppuratuve otitis media. Scott Brown’s Otolaryngology. Volume 6. 1997: 1-29.

Glasscock-Shambaugh. Surgery of the ear. 6th Ed. In: Kumar A, Wiet R, eds. Aural complications of Otitis media. 2010: 447.

Youngs R. Complications of Suppurative Otitis media. In: Ludman H, ed. Wright T Diseases of the ear. Volume 6. 2006: 407-408.

Cummings: Otolaryngology-Head and Neck Surgery. 4th Ed. Philadelphia, PA: Mosby; 2005.

Falconi M, Lauda L. Cochlear fistula in recurrent cholesteatoma. Otol Neurotol. 2006;27:284.

Minor LB. Labyrinthine fistulae. Curr Opin Otolarynol Head Neck Surg. 2003;11:340-6.

Manolidis S. Complications associated with labyrinthine fistula in surgery for chronic otitis media. Otolaryngol Head Neck Surg. 2000;123:733-7.

Chao YH, Yun SH, Shin J O, Yoon JY, Lee DM. Cochlear fistula in Chronic Otitis Media with cholesteatoma. AM J Otol. 1996;17:15-8.

Kobayashi T, Sato T, Toshima M, Ishidoya M, Suetake M, Takasaka. Treatment of labyrinthine fistula with interruption of the semicircular canals. Arch Otolaryngol Head Neck Surg. 1995;121:469-75.

Sanna M, Zini C, Gamoletti R, Taibah A, Russo A, Scandellari R. Closed versus open technique in the management of labyrinthine fistulae. Am J Otol. 1988;9:470-5.

Herzog J, Smith PG, Kletzker GR, Maxwell KS. Management of labyrinthine fistula secondary to cholesteatoma. Am J Otol. 1996;17:410-5.

Sanna M, Zini C, Bacciu S, Scanellari R, Delogu P, Jemmi G. Management of labyrinthine fistula in cholesteatoma surgery. ORL J Otorhinolaryngol Relate Spec. 1984;46:165-72.

Sheehy JL, Brackmann DE. Cholesteatoma surgery management of the labyrinthine fistula a report of 97 cases; Laryngoscope. 1979;89:78-86.

Palva T, Ramsay H. Treatment of labyrinthine fistula. Arch Otolaryngol Head Neck Surg. 1989;115:804-6.

Parisier SC, Edestein DR, Han JC, Weiss MH. Management of labyrinthine fistula caused by cholesteatoma. Otolaryngol Head Neck Surg. 1991;104:110-5.

Gacek RR. The surgical management of labyrinthine fistula in chronic otitis media with cholesteatoma. Ann Otol Rhinol Laryngol. 1974;83:3-19.

Vartianen E. What is the best method of treatment for labyrinthine fistula caused by cholesteatoma? Clin Otol Allied Sci. 1992;17:258-60.

Naderpour M, Mohammadi G, Doostmohammadian N. Management of Labyrinthine fistula and Accompanying Findings: The coexistence of Labyrinthine Fistula and the Facial Canal Dehiscence. Mediterr J of Otol. 2008;4:132-7.

Ghiasi S. Labyrinthine fistula in Chronic Otitis Media with Cholesteatoma. J Pakistan Med Assoc. 2011;3:121-30.

Tos M. Treatment of Labyrinthine Fistulae by a Closed Technique. ORL. 1975;37:41-7.






Original Research Articles