Labyrinthine Fistula

🌀 Labyrinthine Fistula - Circumscribed Labyrinthitis

📖 What is Labyrinthine Fistula?

Labyrinthine fistula is an abnormal communication between the inner ear (labyrinth) and the middle ear.

Which part of labyrinth is involved in labyrinthine fistula?

What is the most common site for Labyrinthine Fistula?

⚠️ Causes of Labyrinthine Fistula

• Most common: Chronic Suppurative Otitis Media (CSOM) with cholesteatoma

• Others:

  • Middle ear neoplasms (carcinoma, glomus tumor)
  • Surgical or accidental trauma to the labyrinth

🩺 Clinical Features of Labyrinthine Fistula

• Many patients remain asymptomatic.

• If symptoms are present:

  • Brief episodes of imbalance, disequilibrium, or vertigo

  • Equilibrium usually normal between episodes

  • Fistula Test positive

  • Nystagmus

  • Tullio’s Phenomenon

What is Fistula Test? How do you perform Fistula Test?

What is Positive Fistula Test?

What is False positive Fistula test? Name some conditions where you see it.

What is False negative Fistula test? Name some conditions where you see it.

What is Hennebert's sign?

What are the different directions of nystagmus on involvement of different semicircular canals in labyrinthine fistula?

What is Tullio’s Phenomenon?

🧪 Investigations of Labyrinthine Fistula

1. Clinical diagnosis — confirmed by fistula test

2. HRCT Temporal Bone — best for detecting bony erosion of semicircular canals

3. MRI — only if intracranial complications are suspected

💉 Treatment of Labyrinthine Fistula

• Surgical:

  • Complete removal of cholesteatoma matrix from fistula site
  • Mastoid exploration and clearance of disease

• Medical:

  • Systemic antibiotics (before and after surgery) to prevent labyrinthine infection spread