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Körmendy KB, Shenker-Horváth K, Shulze Wenning A, Fehérvári P, Harnos A, Hegyi P, Molnár Z, Illés K, Horváth T. Predicting residual cholesteatoma with the Potsic staging system still lacks evidence: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:3557-3568. [PMID: 38351408 PMCID: PMC11211107 DOI: 10.1007/s00405-024-08478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/12/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE To investigate the rate of residual disease in the Potsic staging system for congenital cholesteatomas. METHODS A protocol registration was published on PROSPERO (CRD42022383932), describing residual disease as a primary outcome and hearing improvement as secondary. A systematic search was performed in four databases (PubMed, Embase, Cochrane Library, Web of Science) on December 14, 2022. Articles were included if cholesteatomas were staged according to the Potsic system and follow-up duration was documented. Risk of bias was evaluated using the Quality In Prognosis Studies (QUIPS) tool. In the statistical synthesis a random effects model was used. Between-study heterogeneity was assessed using I2. RESULTS Thirteen articles were found to be eligible for systematic review and seven were included in the meta-analysis section. All records were retrospective cohort studies with high risk of bias. Regarding the proportions of residual disease, analysis using the χ2 test showed no statistically significant difference between Potsic stages after a follow-up of minimum one year (stage I 0.06 (confidence interval (CI) 0.01-0.33); stage II 0.20 (CI 0.09-0.38); stage III 0.06 (CI 0.00-0.61); stage IV: 0.17 (CI 0.01-0.81)). Postoperative and preoperative hearing outcomes could not be analyzed due to varied reporting. Results on cholesteatoma location and mean age at staging were consistent with those previously published. CONCLUSION No statistically significant difference was found in the proportions of residual disease between Potsic stages, thus the staging system's applicability for outcome prediction could not be proven based on the available data. Targeted studies are needed for a higher level of evidence.
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Affiliation(s)
- Klára Borbála Körmendy
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinkszky Hospital, Budapest, Hungary
| | - Kinga Shenker-Horváth
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Morphology and Physiology, Semmelweis University, Budapest, Hungary
- Center for Sports Nutrition Science, Hungarian University of Sports Science, Budapest, Hungary
| | | | - Péter Fehérvári
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- University of Veterinary Medicine Budapest, Budapest, Hungary
| | - Andrea Harnos
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Zsolt Molnár
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
- Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Kata Illés
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinkszky Hospital, Budapest, Hungary
| | - Tamás Horváth
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinkszky Hospital, Budapest, Hungary.
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Xue P, Wang Z, Chai Y, Si M, Hu L. Treatment of congenital middle ear cholesteatoma in children using endoscopic and microscopic ear surgeries: a case series. Front Pediatr 2024; 12:1336183. [PMID: 38853779 PMCID: PMC11157046 DOI: 10.3389/fped.2024.1336183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/29/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Surgical removal is widely employed in children with congenital middle ear cholesteatoma (CMEC). Here, we report the surgical outcomes of CMEC removal via endoscopic ear surgery (EES) and microscopic ear surgery (MES) in children. Methods Children with CMEC who underwent preoperative medical history inquiry, hearing test, endoscopic evaluation, and radiology imaging before receiving EES or MES were included. Postoperative audiological outcomes and recurrence rates were collected. Results Seventeen children (20 ears) with stage II-IV CMEC were included. Of those, 11 ears (55.0%) underwent EES, and 9 ears (45.0%) underwent MES. The follow-up time was 35 ± 13.5 months. One child in the EES group with stage III CMEC had a recurrence during the follow-up period. In the EES group, the average minimum diameter of the external auditory canal on the affected side was 5.8 mm (4.3-8.0 mm). No linear association was found between age and the minimum diameter of the external auditory canal. Discussion EES is a promising treatment option for children with early-stage CMEC because of its low recurrence rate and minimally invasive nature. The minimum diameter of the external auditory canal on the affected side should be meticulously examined when performing EES in children.
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Affiliation(s)
- Po Xue
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Zhaoyan Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Yongchuan Chai
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Mingjue Si
- Department of Radiology, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingxiang Hu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
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Jang HB, Lee JM, Kim DJ, Lee SH, Lee IW, Lee HM. Treatment results for congenital cholesteatoma using transcanal endoscopic ear surgery. Am J Otolaryngol 2022; 43:103567. [DOI: 10.1016/j.amjoto.2022.103567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/13/2022] [Accepted: 07/31/2022] [Indexed: 12/01/2022]
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Jenks CM, Purcell PL, Federici G, Villari D, Presutti L, James AL, Hoff SR. Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma: A Multi-institutional Series. Otolaryngol Head Neck Surg 2021; 167:537-544. [PMID: 34932403 DOI: 10.1177/01945998211067502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess outcomes of transcanal endoscopic ear surgery (TEES) for congenital cholesteatoma. STUDY DESIGN Case series with chart review of children who underwent TEES for congenital cholesteatoma over a 10-year period. SETTING Three tertiary referral centers. METHODS Cholesteatoma extent was classified according to Potsic stage; cases with mastoid extension (Potsic IV) were excluded. Disease characteristics, surgical approach, and outcomes were compared among stages. Outcomes measures included residual or recurrent cholesteatoma and audiometric data. RESULTS Sixty-five cases of congenital cholesteatoma were included. The mean age was 6.5 years (range, 1.2-16), and the mean follow-up was 3.9 years (range, 0.75-9.1). There were 19 cases (29%) of Potsic stage I disease, 10 (15%) stage II, and 36 (55%) stage III. Overall, 24 (37%) patients underwent a second-stage procedure, including 1 with Potsic stage II disease (10%) and 21 (58%) with Potsic stage III disease. Eight cases (12%) of residual cholesteatoma occurred. One patient (2%) developed retraction-type ("recurrent") cholesteatoma. Recidivism occurred only among Potsic stage III cases. Postoperative air conduction hearing thresholds were normal (<25 dB HL) in 93% of Potsic stage I, 88% of stage II, and 36% of stage III cases. CONCLUSION TEES is feasible and effective for removal of congenital cholesteatoma not extending into the mastoid. Recidivism rates were lower with the TEES approach in this large series than in previously reported studies. Advanced-stage disease was the primary risk factor for recidivism and worse hearing result. As minimally invasive TEES is possible in the youngest cases, children benefit from early identification and intervention.
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Affiliation(s)
- Carolyn M Jenks
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patricia L Purcell
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Gaia Federici
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Domenico Villari
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Otolaryngology-Head and Neck Surgery, University Hospital of Bologna, Bologna, Italy
| | - Adrian L James
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Stephen R Hoff
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Division of Otolaryngology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Middle ear congenital cholesteatoma: systematic review, meta-analysis and insights on its pathogenesis. Eur Arch Otorhinolaryngol 2020; 277:987-998. [PMID: 31955213 DOI: 10.1007/s00405-020-05792-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/07/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Congenital cholesteatoma (CC) presents as a white pearl-like lesion behind a normal tympanic membrane (TM), without a history of otorrhea, infection, perforation or previous otologic surgery. Several recent studies provided new data improving this pathology characterization. The aim of this paper is to expand the knowledge about CC and to provide new insights on its pathogenesis. METHODS The study consisted of two main research parts: (1) systematic review and meta-analysis; (2) medical literature review englobing anatomy, histology, embryology and congenital pathology of the ear. RESULTS The search strategy identified a total of 636 papers. Seventy retrospective studies were included. A total of 1497 cases were studied and the mean age was 6.58 years, with a male-female ratio of 3:1, 34% were asymptomatic, 26% had hearing loss and 2% had facial dysfunction/paralysis. The overall estimate for antero-superior quadrant involvement was 0.70 [95% confident interval (CI) 0.64-0.76], in the postero-superior quadrant was 0.60 (95% CI 0.52-0.69), in the antero-inferior quadrant was 0.32 (95% CI 0.23-0.41), in the postero-inferior quadrant was 0.38 (95% CI 0.29-0.47), in the attic was 0.53 (95% CI 0.43-0.63) and in the mastoid was 0.33 (95% CI 0.26-0.41). More advanced Potsic stages were present in older patients. The most likely inclusion place seems to be between the pars flaccida and the upper quadrants of the pars tensa. CONCLUSIONS During the last decades, a substantial improvement in CC diagnosis and management had been achieved. The presented mechanism seems to explain most of middle ear CC.
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Luu K, Chi D, Kiyosaki KK, Chang KW. Updates in Pediatric Cholesteatoma. Otolaryngol Clin North Am 2019; 52:813-823. [DOI: 10.1016/j.otc.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Anikin IA, Knyazev AD, Khamgushkeeva NN, Bokuchava TA. CONGENITAL CHOLESTEATOMA OF THE TEMPORAL BONE: ISSUES ASSOCIATED WITH ITS ETIOLOGY, DIAGNOSTICS AND TREATMENT (A LITERATURE REVIEW). ACTA ACUST UNITED AC 2019. [DOI: 10.25207/1608-6228-2019-26-1-158-167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This article provides a brief literature review on congenital cholesteatoma of the temporal bone. Existing theories describing the development of this pathology are analysed. The diagnostic criteria of congenital cholesteatoma are presented, along with a comparative analysis of the characteristics of various instrumental research methods used in the verification of this disease. Issues involved with the surgical management of such patients are considered.A conclusion is made that, due to the rare occurrence of the congenital cholesteatoma of the temporal bone, diverse theories of its etiology, the lack of clear criteria for its diagnostics, this pathology requires further research to elucidate the nature of the disease and identify the risk groups of its occurrence.Conflict of interest: the authors declare no conflict of interest.
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Affiliation(s)
- Igor’ A. Anikin
- Saint Petersburg Research Institute of Ear, Throat, Nose, and Speech
| | - Anton D. Knyazev
- Saint Petersburg Research Institute of Ear, Throat, Nose, and Speech
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