Objectives: To evaluate the management of cholesteatomas with labyrinthine fistulas (LF), as well as the clinical characteristics and postoperative hearing outcomes in a tertiary general hospital from 2011 to 2018. Design: Retrospective observational cross-sectional study using hospital electronic medical records. Setting: Mastoidectomies done for clinically suspected cholesteatomas. Participants: All patients who underwent primary middle ear mastoidectomy for cholesteatomas. Main outcome measures: Demographic data: age, gender, race, presenting complaints. Preoperative HRCT temporal bone and intraoperative findings. Change in hearing levels preoperatively and postoperatively. Results: 14 of 90 ears (15%) with middle ear cholesteatomas were complicated by LF. HRCT observed 93% sensitivity and 95% specificity in the identification of LFs. Intraoperative findings include stapes erosion in 79% ears (p<0.001), malleus erosion in 79% ears, incus erosion in 93% ears, dehiscence of tegmen tympani in 64% of ears (p=0.016) and tympanic facial canal dehiscence in 45% of ears. Matrix was removed completely in 85% (n=12) and matrix was left behind in 13% (n=2). 21.5% (n=3) had preoperative dead ears. Postoperative hearing results had a mean follow-up time of 2.1 years (1.5, 0.14-4.84). Matrix removal group (n=9) had hearing levels with 78% no change, 11.1% improvement and 11.1% decrease in hearing levels, while matrix preservation group (n=2) had decreased hearing levels. Conclusions: Preservation of hearing in labyrinthine fistulas is possible with cautious matrix removal and immediate repair of the fistula. Longer follow-up of hearing of LF with matrix preservation may show poorer hearing outcomes.