A labyrinthine fistula is the most common complication of cholesteatomatous chronic ear disease. Its treatment remains a controversial subject. The present paper reports our approach to the management of this complication. Operations were performed on 1,226 cases of chronic otitis media with cholesteatoma between January 1971 and December 1985. A labyrinthine fistula was detected in 158 cases. We favor intact canal wall tympanoplasty even in the presence of medium or large fistulas: in the latter case, the matrix is not removed but is trimmed to cover only the bony defect and it is left in place. Open procedures with the preservation of the matrix over the fistula are done in an only-hearing ear with fistula, in ears with a wide defect of the posterior canal wall, and in ears with multiple labyrinthine fistulas. The management of the matrix over the fistula and the anatomic and functional results following each type of procedure are presented and discussed.