A 55-year-old patient with chronic otitis media undergoes canal wall up mastoidectomy. Postoperatively on day 2, the patient develops nystagmus, vertigo, and sensorineural hearing loss. The most likely cause is:
- A Labyrinthine fistula involving the lateral semicircular canal ✓
- B Facial nerve injury at the second genu
- C Postoperative acute otitis media
- D Sigmoid sinus thrombosis
Correct answer: A. Labyrinthine fistula involving the lateral semicircular canal
Explanation
Postoperative vertigo with nystagmo and sensorineural hearing loss after mastoidectomy suggests labyrinthine injury. The lateral semicircular canal is the most common site of iatrogenic labyrinthine fistula in cholesteatoma surgery. This may occur from inadvertent drilling or removal of disease over the canal. Facial nerve injury would cause facial weakness, not vertigo.
Reference: Cummings Otolaryngology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.