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Labyrinthine Fistula

  1. Commonest site: Dome of the lateral semicircular cana
    1. ​Features of nystagmus in the various fistulae
    2. Lateral semicircular canal: horizontal: towards the (N) ear
    3. Superior semicircular canal: Rotatory: towards the (N) ear
    4. Posterior semicircular canal: vertical
  2. Fistula test:
    False negative fistula:-
    1. Dead labyrinth
    2. Cholesteatoma bridging the fistula
    3. Inadequate ear canal sealing

False positive fistula:
MCQ.  Hyper mobile stapes footplate
MCQ.  Congenital syphilis (Hennebert’s sign)              
MCQ.  Transient Vertigo. Hennebert’s sign is a positive fistula sign in the absence of fistula. Seen in congenital syphilis due to excessively mobile stapes.

  1. Treatment
    1. Surgical Treatment
      1. Fistula is seen as a bluish area through the matrix of the cholesteatoma
      2. Overlay with fascia
      3. The matrix of the cholesteatoma can be left behind if there are no underlying granulation tissue.
      4. It the cholesteatoma matrix is left behind à second stage operation is performed after 6-12 months.
    2. P.S.: Caw Thorne/Cooksey exercises: are the various set of exercises designed to restore balance, train the eyes and muscles and joint sense.
      Purpose is to build up tolerance mechanisms in the brain to compensate fix- the in equal balance of the two ears.

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