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Zeng L, Xie L, Hu J, He C, Liu A, Lu X, Zhou W. Osteopontin-driven partial epithelial-mesenchymal transition governs the development of middle ear cholesteatoma. Cell Cycle 2024; 23:537-554. [PMID: 38662954 PMCID: PMC11135870 DOI: 10.1080/15384101.2024.2345481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/17/2024] [Indexed: 05/28/2024] Open
Abstract
Cholesteatoma is a common disease of the middle ear. Currently, surgical removal is the only treatment option and patients face a high risk of relapse. The molecular basis of cholesteatoma remains largely unknown. Here, we show that Osteopontin (OPN), a predominantly secreted protein, plays a crucial role in the development of middle ear cholesteatoma. Global transcriptome analysis revealed the loss of epithelial features and an enhanced immune response in human cholesteatoma tissues. Quantitative RT-PCR and immunohistochemical staining of middle ear cholesteatoma validated the reduced expression of epithelial markers, as well as the elevated expression of mesenchymal markers including Vimentin and Fibronectin, but not N-Cadherin, α-smooth muscle actin (α-SMA) or ferroptosis suppressor protein 1 (FSP1), indicating a partial epithelial-mesenchymal transition (EMT) state. Besides, the expression of OPN was significantly elevated in human cholesteatoma tissues. Treatment with OPN promoted cell proliferation, survival and migration and led to a partial EMT in immortalized human keratinocyte cells. Importantly, blockade of OPN signaling could remarkably improve the cholesteatoma-like symptoms in SD rats. Our mechanistic study demonstrated that the AKT-zinc finger E-box binding homeobox 2 (ZEB2) axis mediated the effects of OPN. Overall, these findings suggest that targeting the OPN signaling represents a promising strategy for the treatment of middle ear cholesteatoma.
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Affiliation(s)
- Lingling Zeng
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Xie
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jin Hu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chao He
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Aiguo Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiang Lu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wen Zhou
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Kadowaki Y, Ide S, Nakamura T, Okuda T, Shigemi H, Hirano T, Takahashi K, Suzuki M. Epidemiology of Congenital Cholesteatoma: Surveys of the Last 17 Years in Japan. J Clin Med 2024; 13:1276. [PMID: 38592124 PMCID: PMC10931836 DOI: 10.3390/jcm13051276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: The incidence of congenital cholesteatoma (CC) has rarely been discussed, particularly from a demographic viewpoint. Therefore, we conducted an epidemiological study of CC using local medical characteristics. (2) Methods: The participants were 100 patients (101 ears) who underwent initial surgical treatment at university hospitals in two rural prefectures between 2006 and 2022. A total of 68% of the patients were males and 32% were females, with a median age of 5 years. We reviewed the medical records for the date of birth, date of surgery, stage of disease, and first symptoms of the disease. (3) Results: The total incidence of CC was calculated to be 26.44 per 100,000 births and tended to increase. No significant difference was found between the incidences in the two prefectures. The number of surgeries performed was higher in the second half of the study period. No difference in the stage of progress was observed based on age. (4) Conclusions: The incidence of CC was estimated to be 26.44 per 100,000 newborn births. The number of patients with CC tended to increase; however, this can be attributed to an increase in the detection rate rather than the incidence.
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Affiliation(s)
- Yoshinori Kadowaki
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan; (Y.K.); (H.S.); (M.S.)
| | - Shinsuke Ide
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Miyazaki University, Miyazaki 889-1601, Japan; (S.I.); (T.N.); (K.T.)
| | - Takeshi Nakamura
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Miyazaki University, Miyazaki 889-1601, Japan; (S.I.); (T.N.); (K.T.)
| | - Takumi Okuda
- Department of Otolaryngology-Head and Neck Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki 880-0017, Japan;
| | - Hideto Shigemi
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan; (Y.K.); (H.S.); (M.S.)
| | - Takashi Hirano
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan; (Y.K.); (H.S.); (M.S.)
| | - Kuniyuki Takahashi
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Miyazaki University, Miyazaki 889-1601, Japan; (S.I.); (T.N.); (K.T.)
| | - Masashi Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan; (Y.K.); (H.S.); (M.S.)
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Hopper SJ, Palmer TT, Khan JA, Manucha V, Carron JD. Myringosclerosis Mimicking Tympanic Membrane Cholesteatoma. EAR, NOSE & THROAT JOURNAL 2024:1455613231223894. [PMID: 38205791 DOI: 10.1177/01455613231223894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Samuel J Hopper
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Trace T Palmer
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Javaria A Khan
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Varsha Manucha
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jeffrey D Carron
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MS, USA
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Daoudi H, Levy R, Baudouin R, Couloigner V, Leboulanger N, Garabédian EN, Belhous K, Boddaert N, Denoyelle F, Simon F. Performance of Non-EPI DW MRI for Pediatric Cholesteatoma Follow-Up. Otolaryngol Head Neck Surg 2024; 170:221-229. [PMID: 37313857 DOI: 10.1002/ohn.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/30/2023] [Accepted: 05/13/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the accuracy, sensitivity, and specificity of nonecho planar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) to detect residual cholesteatoma in children. STUDY DESIGN Retrospective study. SETTING Tertiary comprehensive hospital. METHODS Children operated on for a first-stage cholesteatoma procedure from 2010 to 2019 were included. MRIs were performed with non-EPI DW sequences. Initial reports were collected, indicating the presence or absence of hyperintensity suggestive of cholesteatoma. Three hundred twenty-three MRIs were correlated with the subsequent surgery (66%) or year-later MRI (21%), or were considered accurate if performed 5 years or more after the last surgery (13%). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each imaging procedure for the detection of cholesteatoma were calculated. RESULTS Two hundred twenty-four children with mean age of 9 ± 4 years old presented with cholesteatoma. MRIs were performed 27 ± 24 months after surgery. Residual cholesteatoma was diagnosed in 35%. The sensitivity, specificity, PPV, and NPV of MRI were 62%, 86%, 74%, and 78%, respectively. Accuracy, sensitivity, and specificity increased significantly over time (multivariate analysis). The mean delay after last surgery was of 30 ± 2.0 months for accurate MRI (true positive or negative) versus 17 ± 2.0 months for nonaccurate (false positive or negative) MRIs (p < .001). CONCLUSION However, long the delay after the last surgery, the sensitivity of non-EPI diffusion sequence MRI in children has limitations for the detection of residual cholesteatoma. Surveillance for residual cholesteatoma should incorporate findings at primary surgery, surgeon experience, a low threshold for second-look procedures, and routine imaging.
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Affiliation(s)
- Hannah Daoudi
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Raphaël Levy
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Robin Baudouin
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Vincent Couloigner
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicolas Leboulanger
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eréa-Noel Garabédian
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Kahina Belhous
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Nathalie Boddaert
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Françoise Denoyelle
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - François Simon
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
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Baudouin R, Simon F, Levy R, Breton S, Alciato L, Talab E, Leboulanger N, Couloigner V, Garabedian EN, Denoyelle F. Early Magnetic Resonance Imaging to Diagnose Residual Cholesteatoma in Children and Benefit of Radiological Rereview. Otolaryngol Head Neck Surg 2023; 169:1631-1638. [PMID: 37264987 DOI: 10.1002/ohn.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/28/2023] [Accepted: 05/13/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Non-echo-planar diffusion-weighted (DW) magnetic resonance imaging (non-EPI MRI) is the appropriate sequence to detect residual cholesteatoma. In the child, MRI may be clinically useful to determine the timing of the second-look procedure. The aim of this paper was to retrospectively evaluate the performance of early MRI (before the 18th postoperative month) in detecting residual cholesteatoma in children after review by experienced specialized neuroradiologists. STUDY DESIGN Retrospective study. SETTING One university center comparative cohort. METHODS All patients who had a 2-staged procedure for cholesteatoma with an MRI before the second stage from 2010 to 2020 were included and analyzed. Three pediatric neuroradiologists reviewed all the images blinded to the surgical result. RESULTS N = 141 cholesteatoma events (140 children) were included with a mean age at MRI of 10 (±4) years old. Non-EPI MRIs were performed 10.7 (±3.8) months after the first-stage surgery and 2.2 (±2.6) months before the second-stage procedure. Non-EPI MRI had a 0.57 sensitivity (SE) and 0.83 specificity (SP). MRI was reviewed in 112 cases. The diagnosis was corrected in 17 cases (15.1%) (3 true positives, 7 false negatives, and 7 false positives). SE = 0.63 (p = 0.1) and SP = 0.92 (p = 0.08) after rereading. CONCLUSION Early MRI's SE is poor but SP is excellent after rereading. Evidence does not support the use of early non-EPI MRI to modify the surgical strategy or to postpone the second look. If performed, early non-EPI MRI should be read by specialized experienced radiologists with all 3 sequences (T1, T2, and non-EPI DW) and apparent diffusion coefficient calculation, especially in cases of otitis media with effusion.
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Affiliation(s)
- Robin Baudouin
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - François Simon
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Raphaël Levy
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Sylvain Breton
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
- Department of Radiology, Paris Imagerie 114, Paris, France
| | - Lauranne Alciato
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Elsa Talab
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicolas Leboulanger
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Couloigner
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Erea-Noël Garabedian
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Françoise Denoyelle
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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Alhazmi WA, Al Mansour MH, Aljasser RI, Alanazi AM, Alyami SD, Almutairi AB, Al Sulaiman IN. A Brief Review of Demographic and Clinical Correlates of Cholesteatoma Surgery in the Qassim Region. Cureus 2023; 15:e35676. [PMID: 37012962 PMCID: PMC10066465 DOI: 10.7759/cureus.35676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Background Cholesteatoma is described as the accumulation of squamous epithelium and keratinocytes within and around the middle ear cleft. There is a paucity of information regarding demographic and treatment outcomes for cholesteatoma in Saudi Arabia. An evaluation of the prevalence of comorbidities, complications and associations, of surgical treatment and demographics in the Qassim region was conducted. Methods This was a six-year retrospective review of patients treated for cholesteatoma at a private health facility, from August 2016 to July 2022. Data for age, gender, nationality, presence of comorbidities, type of surgery, type of anesthesia, and associated complications were collected from the electronic medical records and analyzed with Statistical Package for Social Sciences software. Results A total of 60 participants records were retrieved. The average age of the study population was ([43.2 ±SD] 21.8) years. There was a slightly higher male preponderance (males 51.7% and females 48.3%). Hypertension was the most commonly reported comorbidity (31.7%), followed by diabetes mellitus (25%). Age and gender were not statistically significantly associated with type of surgery or complications. Conclusion Demographic variables were not significantly associated with clinical correlates, however, further studies with larger sample sizes, robust clinical information, and long-term follow-up are required.
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Wang X, Guo J, Liu W, Chen M, Shao J, Zhang X, Ma N, Li Y, Peng Y, Zhang J. Comparison of the EAONO/JOS, STAMCO and ChOLE cholesteatoma staging systems in the prognostic evaluation of acquired middle ear cholesteatoma in children. Eur Arch Otorhinolaryngol 2022; 279:5583-5590. [PMID: 35554663 DOI: 10.1007/s00405-022-07400-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/11/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To compare the performance of the EAONO/JOS, STAMCO, and ChOLE Cholesteatoma Staging Systems in prognostic evaluation of children acquired middle ear cholesteatoma after primary surgery and identify the other factors that could predict cholesteatoma recidivism. And the correlation between the staging and the recidivism of cholesteatoma after grouping according to operation was evaluated. METHODS A total of 123 ears of 118 patients that underwent surgery for primary cholesteatoma from November 2008 to May 2020 were included in this retrospective study, and then classified and staged according to the EAONO/JOS, STAMCO, and ChOLE cholesteatoma staging system, respectively. Each indicator involved in the system above was analyzed separately to evaluate its prognostic value for cholesteatoma recidivism. RESULTS The type of surgical procedure performed (P = 0.020) was shown to be associated with cholesteatoma recidivism. Cholesteatoma location the supratubal recess (S1) (P = 0.026, HR = 3.614, 95% CI 1.137, 7.945), and the sinus tympani (S2) (P = 0.004, HR = 4.208, 95% CI 1.574, 11.250) were shown to be significantly associated with disease recidivism. When focusing on the CWU operation group, ossicular chain status in STAMCO stage (P = 0.043) and in the ChOLE stage (P = 0.018) were significantly associated with cholesteatoma recidivism. The results had shown no association between the three stages and cholesteatoma recidivism in the CWD and endoscopic surgery groups. CONCLUSIONS Based on our study, the EAONO/JOS, STAMCO, and ChOLE Classifications have limited value in predicting cholesteatoma recidivism, in acquired middle ear cholesteatoma in children. Adding the pathological status of the ossicular chain may be useful for predicting the recidivism of cholesteatoma. Additional validation studies are entailed to definitively assess the clinical utility of these classifications.
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Affiliation(s)
- Xiaoxu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - Jianlin Guo
- Department of Radiology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Wei Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - Min Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - Jianbo Shao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - Xiao Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - Ning Ma
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - Yanhong Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - Yun Peng
- Department of Radiology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China.
| | - Jie Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China. .,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China.
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Muacevic A, Adler JR. Diagnosis and Treatment Modalities of Cholesteatomas: A Review. Cureus 2022; 14:e31153. [PMID: 36505121 PMCID: PMC9731553 DOI: 10.7759/cureus.31153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/06/2022] [Indexed: 11/08/2022] Open
Abstract
A cholesteatoma is an abnormal, noncancerous skin growth that can appear beneath the eardrum in the center of your ear. Although it might be a congenital condition, frequent middle ear infections are the main culprit. A cholesteatoma frequently appears as a cyst or sac that exfoliates the skin's outer layers. As these dead skin cells build up, the growth can enlarge and penetrate intratemporal tissues, leading to various intracranial and extracranial difficulties that can compromise facial muscles, hearing, and balance. Cholesteatomas were recognized more than three centuries ago. A cholesteatoma can develop into a serious condition if it is not treated right away. Because of its fast development and invasive nature, it can cause several consequences, some of which can be fatal for people without access to advanced medical treatment. There are no effective nonsurgical treatments available right now. It will be necessary to have a thorough awareness of both previous developments and more current ones to develop an appropriate management approach for this condition. The background information on acquired middle ear cholesteatomas is briefly reviewed in this paper. We also take into account categorization-, epidemiology-, histology-, and pathogenesis-related difficulties, and we carefully review current management and diagnosis approaches.
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Review of Transcanal Endoscopic Ear Surgery (TEES) and Bioengineering for Pediatric Otologic Surgery. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00417-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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10
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In vitro study on immune response modifiers as novel medical treatment options for cholesteatoma. Int J Pediatr Otorhinolaryngol 2021; 145:110743. [PMID: 33933986 DOI: 10.1016/j.ijporl.2021.110743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/24/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate cytokine profile of cholesteatoma and to collect information about important intercellular signaling pathways by establishing two different cell culture models, to block important intercellular signaling pathways in cholesteatoma by applying immune system modifier drugs to develop alternative medical therapy options for cholesteatoma. METHODS To observe the pathogenesis of cholesteatoma and to apply the immunomodulatory drugs, cholesteatoma tissue culture models were constituted with HEKa cells and cholesteatoma keratinocytes, which were obtained from 3 patients who underwent operations for cholesteatoma. Medicines including 5-fluorourasil, imiquimod, cyclosporine, and tacrolimus were applied on both cholesteatoma keratinocytes and HEKa cells. After 48 h of incubation, IL-1, IL-6, IL-8, IL-10, TNF-α, and Ki67 levels were measured to determine cell viability rates. RESULTS In the cholesteatoma control group, IL-6 and TNF-α levels were found higher than in the HEKa control group. All repurposed drugs in the study demonstrated anti-inflammatory, anti-proliferative, and cytotoxic effects on cholesteatoma. Imiquimod and tacrolimus in particular are potential treatment prospects for cholesteatoma due to their strong anti-inflammatory and cytotoxic effects. CONCLUSION Medical therapy options for cholesteatoma are still missing and surgery is not the ultimate solution. We have focused on intercellular inflammatory processes, which play significant roles in the pathogenesis of cholesteatoma in our paper. Inflammation and proliferation of cholesteatoma decreased after all repurposed drug applications in our study. Anti-inflammatory and anti-proliferative effects of tacrolimus and imiquimod was more significant than other drugs in the study. For this reason, tacrolimus and imiquimod should be examined in depth with in vivo studies in terms of efficacy and safety for medical treatment of cholesteatoma.
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Viana RMM, Souza JP, Jorge DMM, Martins RB, Castro IA, Cardoso RS, Volpini LPB, de Souza Luna LK, Spano LC, Bellei NCJ, Chahud F, Arruda E, A Hyppolito M. Detection of respiratory viruses in primary cholesteatoma tissues. J Med Virol 2021; 93:6132-6139. [PMID: 34050944 DOI: 10.1002/jmv.27107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/08/2022]
Abstract
Cholesteatomas are frequent middle ear benign tumors of unknown etiology. Infectious agents have been considered as possible contributing factors in the pathogenesis of cholesteatomas. Aiming to investigate the presence of respiratory viruses in primary cholesteatoma tissues, 26 formalin-fixed paraffin-embedded primary cholesteatoma tissues obtained from patients seen at the of the Clinical Hospital of the University of São Paulo School of Medicine, in Ribeirão Preto, Brazil were tested by real-time polymerase chain reaction (PCR). Considering the PCR results, 35% of the tissues were positive for human rhinovirus (HRV), 15.3% for human enterovirus (EV), 3.8% for human metapneumovirus (HMPV), and 3.8% for human bocavirus (HBoV). Serial immunohistochemistry for virus antigens and cell surface markers evidenced that the viruses were associated with fibroblasts, dendritic cells, macrophages, B lymphocytes, CD4+ , and CD8+ T lymphocytes. These findings indicate for the first time the presence of active respiratory virus infection in primary cholesteatoma tissues, suggesting that persisting virus infection in the middle could play a role in the pathogenesis and evolution of cholesteatomas.
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Affiliation(s)
- Rosa M M Viana
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.,Department of Molecular and Cell Biology, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Juliano P Souza
- Department of Molecular and Cell Biology, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Daniel M M Jorge
- Department of Molecular and Cell Biology, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Ronaldo B Martins
- Department of Molecular and Cell Biology, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Italo A Castro
- Department of Molecular and Cell Biology, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Ricardo S Cardoso
- Department of Molecular and Cell Biology, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Lays P B Volpini
- Post-Graduate Program in infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil
| | - Luciano K de Souza Luna
- Medicine Department, Clinical Virology Laboratory, Infectious Diseases Unit, São Paulo Federal University, São Paulo, Brazil
| | - Liliana C Spano
- Post-Graduate Program in infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil.,Departament of Pathology, Center of Health Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | - Nancy C J Bellei
- Medicine Department, Clinical Virology Laboratory, Infectious Diseases Unit, São Paulo Federal University, São Paulo, Brazil
| | - Fernando Chahud
- Department of Pathology and Forensic Medicine, Ribeirão Preto School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Eurico Arruda
- Department of Molecular and Cell Biology, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Miguel A Hyppolito
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
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12
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Benson JC, Carlson ML, Lane JI. Non-EPI versus Multishot EPI DWI in Cholesteatoma Detection: Correlation with Operative Findings. AJNR Am J Neuroradiol 2021; 42:573-577. [PMID: 33334855 DOI: 10.3174/ajnr.a6911] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/29/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Although multishot EPI (readout-segmented EPI) has been touted as a robust DWI sequence for cholesteatoma evaluation, its efficacy in disease detection compared with a non-EPI (eg, HASTE) technique is unknown. This study sought to compare the accuracy of readout-segmented EPI with that of HASTE DWI in cholesteatoma detection. MATERIALS AND METHODS A retrospective review was completed of consecutive patients who underwent MR imaging for the evaluation of suspected primary or recurrent/residual cholesteatomas. Included patients had MR imaging examinations that included both HASTE and readout-segmented EPI sequences and confirmed cholesteatomas on a subsequent operation. Two neuroradiologist reviewers assessed all images, with discrepancies resolved by consensus. The ratio of signal intensity between the cerebellum and any observed lesion was noted. RESULTS Of 23 included patients, 12 (52.2%) were women (average age, 47.8 [SD, 25.2] years). All patients had surgically confirmed cholesteatomas: Six (26.1%) were primary and 17 (73.9%) were recidivistic. HASTE images correctly identified cholesteatomas in 100.0% of patients. On readout-segmented EPI sequences, 16 (69.6%) were positive, 5 (21.7%) were equivocal, and 2 (8.7%) were falsely negative. Excellent interobserver agreement was noted between reviews on both HASTE (κ = 1.0) and readout-segmented EPI (κ = 0.9) sequences. The average signal intensity ratio was significantly higher on HASTE than in readout-segmented EPI, facilitating enhanced detection (mean difference 0.5; 95% CI, 0.3-0.8; P = .003). CONCLUSIONS HASTE outperforms readout-segmented EPI in the detection of primary cholesteatoma and disease recidivism.
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Affiliation(s)
- J C Benson
- Department of Radiology (J.C.B., J.I.L.)
| | - M L Carlson
- Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, Rochester, Minnesota
| | - J I Lane
- Department of Radiology (J.C.B., J.I.L.)
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13
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Olivé-Busom J, López-Costas O, Quer-Agustí M, Márquez-Grant N, Kirchner H. Evidence of otitis media and mastoiditis in a Medieval Islamic skeleton from Spain and possible implications for ancient surgical treatment of the condition. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2021; 32:17-22. [PMID: 33232880 DOI: 10.1016/j.ijpp.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate lesions on a cranium from the Iberian Peninsula and assess its medico-historical and paleopathological significance. MATERIALS The skeletal remains of a juvenile individual found in a Medieval Islamic grave (10th -16th century) in Eastern Spain. METHODS Macroscopic examination of the left and right temporal bones, binocular microscopy, X-ray, and Scanning Electron Microscopy - Energy Dispersive X-ray Spectroscopy (SEM-EDS) were performed. RESULTS A sub-oval perforation superior to the right mastoid process and pathological changes on the right temporal bone were identified. SEM-EDS confirmed the presence of copper in the surrounding area of the perforation. CONCLUSIONS The observed pathological changes are most likely compatible with otitis media and subsequent mastoiditis. The sub-oval perforation could be interpreted either as an abscess or as evidence of a surgical procedure (mastoidectomy) or a combination of both; and the Cu traces may be the result of an associated object or, possibly, the application of a plaster with copper acetate used as medical treatment. SIGNIFICANCE This case contributes to the paleopathological record and the interpretation of similar cases, and also helps in the understanding of medical care and treatment in Medieval Islam. LIMITATIONS The lack of similar pre-modern cases of surgical intervention limits comparability to clinical cases. Suggestion for further research: Exploration into indicators of health care in past populations.
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Affiliation(s)
- Júlia Olivé-Busom
- Departament de Ciències de l'Antiguitat I l'Edat Mitjana, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Spain.
| | - Olalla López-Costas
- Group EcoPast (GI-1553), Universidade de Santiago de Compostela, Santiago de Compostela, 15782, Spain; Archaeological Research Laboratory, Stockholm University, Wallenberglaboratoriet, SE-10691, Stockholm, Sweden; Laboratorio de Antropología Física, Facultad de Medicina, Universidad de Granada, Granada, 18012, Spain.
| | - Miquel Quer-Agustí
- Departament de Cirurgia Àrea d'Otorrinolaringologia, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Spain.
| | - Nicholas Márquez-Grant
- Cranfield Forensic Institute, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, SN6 8LA, United Kingdom.
| | - Helena Kirchner
- Departament de Ciències de l'Antiguitat I l'Edat Mitjana, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Spain.
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15
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McCabe R, Lee DJ, Fina M. The Endoscopic Management of Congenital Cholesteatoma. Otolaryngol Clin North Am 2020; 54:111-123. [PMID: 33153732 DOI: 10.1016/j.otc.2020.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital cholesteatoma is a rare, primarily pediatric disease that presents in otherwise healthy ears. Typically, this disease is found in a well-defined sac in the middle ear, making it particularly suited for removal through transcanal endoscopic ear surgery. This article reviews the ways in which endoscopy can be applied to the surgical management of congenital cholesteatoma and provides a guide based on congenital cholesteatoma stage and extent. Outcomes have shown similar rates of residual disease in total endoscopic ear surgery compared with operative microscopy.
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Affiliation(s)
- Rachel McCabe
- Department of Otolaryngology, University of Minnesota, 420 Delaware Street Southeast, MMC 396, Minneapolis, MN 55455, USA
| | - Daniel J Lee
- Pediatric Otology and Neurotology, Department of Otology and Laryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
| | - Manuela Fina
- Department of Otolaryngology, University of Minnesota, HealthPartners Medical Group, 401 Phalen Blvd, St Paul, MN 55130, USA.
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16
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Fontes Lima A, Carvalho Moreira F, Sousa Menezes A, Esteves Costa I, Azevedo C, Sá Breda M, Dias L. Is pediatric cholesteatoma more aggressive in children than in adults? A comparative study using the EAONO/JOS classification. Int J Pediatr Otorhinolaryngol 2020; 138:110170. [PMID: 32705986 DOI: 10.1016/j.ijporl.2020.110170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION chronic otitis media with cholesteatoma (COMC) is a serious condition that may cause severe complications. According to the literature, in pediatric patients this entity can have a more aggressive behavior, leading to higher rates of morbidity. Consensus regarding the definition of aggressive and extensive cholesteatoma was lacking until recently. European Academy of Otology and Neurotology/Japan Otologic Society (EAONO/JOS) proposed a classification and staging system which was highly accepted by a group of otology experts. OBJECTIVE to compare cholesteatoma characteristics between pediatric and adult patients using the EAONO/JOS stating system. MATERIAL AND METHODS a retrospective analysis of the patients who underwent surgery for cholesteatoma treatment in a tertiary hospital was performed using EAONO/JOS classification. Congenital cholesteatoma, revision surgery, and follow-up losses were excluded. The patients were further divided into two cohorts: a pediatric group (<16 years old) and an adult group (>16 years old). The results were compared between them. RESULTS 134 patients fulfilled the inclusion criteria, 27 were pediatric, and 107 adult patients. We found a significant difference in supratubal recess, with higher rates of extension to this location in the pediatric group. Also in the pediatric cohort, COMC was accompanied by malleus erosion in a higher frequency, with a significant difference from adults; it also presented in higher stages of the disease according to EAONO/JOS classification. We found no differences in hearing gain post-operatively. Moreover, we found that age younger than 16 years was an independent risk factor for relapse with time. DISCUSSION AND CONCLUSIONS according to our data, cholesteatoma in pediatric age has a more aggressive and extensive nature than in adults, and age younger than 16-years-old is an independent risk factor for relapse.
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Affiliation(s)
- António Fontes Lima
- Department of Otorhinolaryngology, Hospital de Braga, 4715, Braga, Portugal.
| | | | - Ana Sousa Menezes
- Department of Otorhinolaryngology, Hospital de Braga, 4715, Braga, Portugal
| | | | - Cátia Azevedo
- Department of Otorhinolaryngology, Hospital de Braga, 4715, Braga, Portugal
| | - Miguel Sá Breda
- Department of Otorhinolaryngology, Hospital de Braga, 4715, Braga, Portugal
| | - Luís Dias
- Department of Otorhinolaryngology, Hospital de Braga, 4715, Braga, Portugal
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Jiang J, Chu G, Chen G, Liao H, Yu L, Yu H, Liu J, Hu Z. A case report of rare intraperitoneal cholesteatoma diagnosed and treated through multidisciplinary collaboration. Clin Case Rep 2020; 8:1965-1970. [PMID: 33088530 PMCID: PMC7562891 DOI: 10.1002/ccr3.3075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/26/2020] [Indexed: 11/06/2022] Open
Abstract
55‐year‐old female patient with abdominal distension and poor appetite for 3 months was diagnosed as intraperitoneal cholesteatoma by imaging findings and histological tests. Patient has received surgical resection and recovered well after operation.
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Affiliation(s)
- Jie Jiang
- Department of Hepatobiliary Surgery The First People's Hospital of Kunming City & Galmette Affiliated Hospital of Kunming Medical University Kunming China
| | - Guang Chu
- Department of Hepatobiliary Surgery The First People's Hospital of Kunming City & Galmette Affiliated Hospital of Kunming Medical University Kunming China
| | - Gang Chen
- Department of Hepatobiliary Surgery The First People's Hospital of Kunming City & Galmette Affiliated Hospital of Kunming Medical University Kunming China
| | - Hongyun Liao
- Department of Hepatobiliary Surgery The First People's Hospital of Kunming City & Galmette Affiliated Hospital of Kunming Medical University Kunming China
| | - Lu Yu
- Department of Hepatobiliary Surgery The First People's Hospital of Kunming City & Galmette Affiliated Hospital of Kunming Medical University Kunming China
| | - Hongjun Yu
- Department of Hepatobiliary Surgery The First People's Hospital of Kunming City & Galmette Affiliated Hospital of Kunming Medical University Kunming China
| | - Jie Liu
- Department of Hepatobiliary Surgery The First People's Hospital of Kunming City & Galmette Affiliated Hospital of Kunming Medical University Kunming China
| | - Zongqiang Hu
- Department of Hepatobiliary Surgery The First People's Hospital of Kunming City & Galmette Affiliated Hospital of Kunming Medical University Kunming China
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Abstract
OBJECTIVE To describe malformations associated with pediatric congenital cholesteatomas of the middle ear. STUDY DESIGN Retrospective study. SETTING Tertiary referral center. PATIENTS One hundred and seventy-three cases of middle ear congenital cholesteatoma (CC) in 171 children operated between 2007 and 2017. INTERVENTIONS Demographic, clinical, and surgical data were collected from operative reports. MAIN OUTCOME MEASURES We first described the type and rate of malformations associated with CC. Secondly, we compared cholesteatoma features in two subgroups: anterior superior (AS) versus posterior superior (PS) starting point. Third, we compared demographic, clinical, and surgical data between patients with and without malformation. RESULTS CC was associated with malformations in 17 cases (17/173; 9.8%). The main malformation was preauricular fistula (8/173; 4.6%). Other malformations were: one first branchial cleft, two labio palatine cleft, one nasal cyst, two preauricular fibrochondroma, and five other malformations. PS congenital cholesteatomas were diagnosed in older children (4.6 versus 8.6 years, p < 0.05) and had greater extension in middle ear than the AS cholesteatoma (39.7% versus 95.8%, p < 0.05). We did not find any significant difference between these two groups regarding the associated malformations. We did not find a difference in clinical presentation of CC between patients with and without associated malformation. CONCLUSIONS We found various associated malformations in 9.8% of CC cases with no statistical difference in the malformation rate between AS and PS groups. All the malformations were located in the craniofacial region suggesting that genes implicated in craniofacial development may play a role in the pathophysiology of CC.
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Lee JA, Fuller SR, Nguyen SA, Meyer TA. Factors affecting complications and comorbidities in children with cholesteatoma. Int J Pediatr Otorhinolaryngol 2020; 135:110080. [PMID: 32413646 DOI: 10.1016/j.ijporl.2020.110080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the effects of age, race, payer status, and socioeconomic status on complications and comorbidities in children with cholesteatoma. METHODS An analysis of the Kids' Inpatient Database was performed on cases of cholesteatoma between 2006 and 2016, along with associated complications or co-morbidities and surgical interventions. RESULTS 1552 cases of pediatric cholesteatoma represented 5.6 cases per 100,000 total discharges over the study period. The mean age was 9.9 (±5.4) years. Compared to children in the 4th age quartile, those in the 1st age quartile had decreased risk of conductive hearing loss (OR 0.64 [0.42-0.99]), venous thrombosis (OR 0.24 [0.06-0.88]), intracranial abscess (OR 0.35 [0.13-0.96]), and facial nerve palsy (0.44 [0.20-0.97]), but increased risk of chronic otitis media (OR 2.24 [1.23-4.10]). Compared to children identified as Other race, children identified as Black had increased risk of acute otitis media (OR 9.20 [1.35-62.78]). Both children identified as Black (OR 9.90 [1.48-66.35]) or Hispanic (OR 6.24 [1.01-38.51]) had increased risk of facial nerve palsy. Relative to children in the 4th income quartile, children in the 1st income quartile had increased risk of acute mastoiditis (OR 1.87 [1.15-3.03]) and subperiosteal abscess (OR 6.75 [2.22-20.56]). Children in the 2nd income quartile were less likely to receive ossicular chain surgery (OR 0.31 [0.13-0.72]). CONCLUSION Differences pertaining to age, race, payer status, and socioeconomic status exist in the presentation and surgical management of children hospitalized with cholesteatoma. Older children are at increased risk of intracranial complications. Patients of Black and Hispanic race might have a higher risk of facial nerve palsy. Compared to children of higher income families, those from lower income families more frequently develop acute mastoiditis and subperiosteal abscess. Providers should be mindful of these risk factors when caring for children with cholesteatoma.
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Affiliation(s)
- Joshua A Lee
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - Stephen R Fuller
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ted A Meyer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Solanki B, Sharma S. Cholesteatoma Versus Granulations: Changing Incidence Trends and Association with Age and Complications. Indian J Otolaryngol Head Neck Surg 2020; 72:208-213. [PMID: 32551279 DOI: 10.1007/s12070-019-01765-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose CSOM is a common disease in lower socio-economic set-ups. Its incidence has decreased over time due to improved hygiene status increased use of antibiotics. It can be associated with cholesteatoma or granulation tissue as far as unsafe ears are considered. Cholesteatoma is defined as a well demarcated noncancerous cystic lesion derived from an abnormal growth of keratinising squamous epithelium in the temporal bone, commonly characterised as skin in the wrong place. Granulations are defined as the inflammatory response of middle ear mucosa to toxic insults. Overtime the incidence of granulations has increased. This study aims to observe the incidence trends of cholesteatoma in comparison to granulation tissue as intraoperative finding in CSOM patients and the association of these two with the age of the patient and associated complications if present. Materials and Methods All the patients admitted to E.N.T ward of M.D.M. Hospital, Jodhpur, Rajasthan, India undergoing mastoid exploration surgery between the time period of 1 year from September 2017 to August 2018 were observed and their clinical findings along with patients data including age and sex were recorded and studied in regard with incidence of cholesteatoma, granulation tissue or both simultaneously along with associated complications. Results Majority of the patients who required mastoid exploration surgery had the presence of granulation tissue as intraoperative finding (55.07%). The incidence of cholesteatoma and both cholesteatoma and granulations together was (21.73%) and (23.18%) respectively. Complication percentage was highest with that of cholesteatoma patients (44.45%). Most of the patients presented in the 3rd-4th decade of their lives (63.77%) and the incidence was low amongst the children (30.43%) and the elderly (5.8%). The complication rate was higher in children (55.56%). Conclusion Granulation tissue showed an increased incidence trend as compared with cholesteatoma; although complication rate was higher in the latter. Incidence as a function of age was maximum in the middle ages but the complication rate was more amongst the children.
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Affiliation(s)
- Bharti Solanki
- Department of Otorhinolaryngology and Head Neck Surgery, Dr.S.N.Medical College and M.D.M. Hospital, Room 88, Old P.G Boys Hostel, M.D.M Hospital Campus, Shashtri Nagar, Jodhpur, Rajasthan 342003 India
| | - Shivam Sharma
- Department of Otorhinolaryngology and Head Neck Surgery, Dr.S.N.Medical College and M.D.M. Hospital, Room 88, Old P.G Boys Hostel, M.D.M Hospital Campus, Shashtri Nagar, Jodhpur, Rajasthan 342003 India
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Sheng Y, Hong R, Sha Y, Zhang Z, Zhou K, Fu C. Performance of TGSE BLADE DWI compared with RESOLVE DWI in the diagnosis of cholesteatoma. BMC Med Imaging 2020; 20:40. [PMID: 32306913 PMCID: PMC7168963 DOI: 10.1186/s12880-020-00438-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/30/2020] [Indexed: 12/17/2022] Open
Abstract
Background Based on its high resolution in soft tissue, MRI, especially diffusion-weighted imaging (DWI), is increasingly important in the evaluation of cholesteatoma. The purpose of this study was to evaluate the role of the 2D turbo gradient- and spin-echo (TGSE) diffusion-weighted (DW) pulse sequence with the BLADE trajectory technique in the diagnosis of cholesteatoma at 3 T and to qualitatively and quantitatively compare image quality between the TGSE BLADE and RESOLVE methods. Method A total of 42 patients (23 males, 19 females; age range, 7–65 years; mean, 40.1 years) with surgically confirmed cholesteatoma in the middle ear were enrolled in this study. All patients underwent DWI (both a prototype TGSE BLADE DWI sequence and the RESOLVE DWI sequence) using a 3-T scanner with a 64-channel brain coil. Qualitative imaging parameters (imaging sharpness, geometric distortion, ghosting artifacts, and overall imaging quality) and quantitative imaging parameters (apparent diffusion coefficient [ADC], signal-to-noise ratio [SNR], contrast, and contrast-to-noise ratio [CNR]) were assessed for the two diffusion acquisition techniques by two independent radiologists. Result A comparison of qualitative scores indicated that TGSE BLADE DWI produced less geometric distortion, fewer ghosting artifacts (P < 0.001) and higher image quality (P < 0.001) than were observed for RESOLVE DWI. A comparison of the evaluated quantitative image parameters between TGSE and RESOLVE showed that TGSE BLADE DWI produced a significantly lower SNR (P < 0.001) and higher parameter values (both contrast and CNR (P < 0.001)) than were found for RESOLVE DWI. The ADC (P < 0.001) was significantly lower for TGSE BLADE DWI (0.763 × 10− 3 mm2/s) than RESOLVE DWI (0.928 × 10− 3 mm2/s). Conclusion Compared with RESOLVE DWI, TGSE BLADE DWI significantly improved the image quality of cholesteatoma by reducing magnetic sensitive artifacts, distortion, and blurring. TGSE BLADE DWI is more valuable than RESOLVE DWI for the diagnosis of small-sized (2 mm) cholesteatoma lesions. However, TGSE BLADE DWI also has some disadvantages: the whole image intensity is slightly low, so that the anatomical details of the air-bone interface are not shown well, and this shortcoming should be improved in the future.
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Affiliation(s)
- Yaru Sheng
- Department of Radiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Rujian Hong
- Department of Radiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Yan Sha
- Department of Radiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
| | | | - Kun Zhou
- Department of Digitalization, Siemens Shenzhen Magnetic Resonance, Ltd., Shenzhen, China
| | - Caixia Fu
- Department of Digitalization, Siemens Shenzhen Magnetic Resonance, Ltd., Shenzhen, China
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Westerberg J, Mäki-Torkko E, Harder H. The evaluation of canal wall up cholesteatoma surgery with the Glasgow Benefit Inventory. Eur Arch Otorhinolaryngol 2019; 277:61-68. [PMID: 31586256 PMCID: PMC6942595 DOI: 10.1007/s00405-019-05670-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/24/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the study was to investigate the change in health-related quality of life (HRQoL) after canal wall up cholesteatoma surgery, using the Glasgow Benefit Inventory (GBI). METHODS Data from a consecutive group of 47 adults scheduled for primary cholesteatoma surgery using canal wall up (CWU) with obliteration, from January 2005 to December 2009, were analysed. Information was extracted from a medical database, and complementary data from patient files and audiograms were collected and recorded retrospectively. The GBI questionnaire was used for the assessment of HRQoL after surgery. RESULTS There was no finding of residual or recurrent cholesteatomas in the study group. Hearing was improved at 1 and 3 years postoperatively. No patient suffered a total hearing loss. The overall GBI scores showed an improved HRQoL after surgery. Twenty-nine (85%) patients benefitted from surgery, 1 (3%) had no change, and 4 (12%) expressed deterioration. CONCLUSIONS Cholesteatoma surgery using CWU with obliteration gives an improved HRQoL for the majority of patients. The GBI questionnaire provides complementary information to hearing and healing results after cholesteatoma surgery.
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Affiliation(s)
- Johanna Westerberg
- Division of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. .,Department of Otorhinolaryngology in Linköping, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden. .,ENT Clinic, University Hospital, 582 85, Linköping, Sweden.
| | - Elina Mäki-Torkko
- Division of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Otorhinolaryngology in Linköping, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden.,Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.,Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden
| | - Henrik Harder
- Division of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Otorhinolaryngology in Linköping, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden.,ENT Clinic, University Hospital, 582 85, Linköping, Sweden
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Imaging of temporal bone inflammations in children: a pictorial review. Neuroradiology 2019; 61:959-970. [DOI: 10.1007/s00234-019-02258-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/02/2019] [Indexed: 02/04/2023]
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Chemically Assisted Dissection With Sodium 2-Mercaptoethanesulfonate (MESNA) in the Surgical Management of Pediatric Cholesteatoma. Otol Neurotol 2019; 40:645-650. [DOI: 10.1097/mao.0000000000002174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Diffusion-weighted magnetic resonance imaging in the detection of residual and recurrent cholesteatoma in children: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2019; 118:90-96. [PMID: 30599286 DOI: 10.1016/j.ijporl.2018.12.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/21/2018] [Accepted: 12/23/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the performance of diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of residual and recurrent cholesteatoma in children. METHODS A systematic review and meta-analysis was conducted as per PRISMA guidelines using the following databases from their date of inception: MEDLINE, PubMed, Embase, Cochrane Library, Web of Science. Bivariate meta-analysis using a random effects model was used to calculate summarized pooled estimates of sensitivity, specificity, and diagnostic odds ratios, using second-look surgery as the gold standard comparison. RESULTS A total of ten articles (141 cases) were included for qualitative and quantitative analysis. Pooled sensitivity and specificity of non-echo planar imaging (non-EPI) DW-MRI were 89.4% (95%CI 51.9%-98.5%) and 92.9% (95%CI 81.4%-97.5%) respectively. DW-MRI appears limited in its ability to detect lesions less than 3 mm in size. CONCLUSION Non-EPI DW-MRI is highly specific but carries uncertain sensitivity in the detection of residual and recurrent cholesteatoma in children. Further research is warranted to determine the specific role of DW-MRI in this patient group, namely when and how often children should be referred for imaging and in which cases the method can be used to completely replace second-look surgery.
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Aural Polyp is not Always Due to Chronic Otitis Media (COM): Preoperative Computed Tomographic Scan is Good Pointer for Sinister Lesions. Indian J Otolaryngol Head Neck Surg 2018; 70:505-509. [PMID: 30464906 DOI: 10.1007/s12070-018-1482-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022] Open
Abstract
Twenty five patients of aural polyp who underwent canal wall down mastoidectomy were analysed retrospectively. Histopathological examination revealed cholesteatoma in 22 (88%) patients. However, histopathological diagnosis in 3 of these patients was unusual and rare benign tumors of the middle ear cleft-meningioma, neurilemmoma and capillary hemangioma. Review of the preoperative High Resolution Computed Tomography (HRCT) temporal bone revealed an unusual picture in all of the three cases. Features noted were: widening of the jugular foramen (meningioma), destruction of the anterior wall of mesotympanum (neurilemmoma), enhancing soft tissue density lesion (capillary hemangioma). Further, there was only partial loss of pneumatisation of the mastoid air cells in all of the 3 cases. It was observed that though HRCT temporal bone is a commonly advised investigation in patients of chronic otitis media (COM) with aural polyp, meticulous interpretation may reveal unusual features pointing towards sinister diagnosis. Conclusion: Aural polyp with preservation of pneumatisation of mastoid air cells points towards diagnosis other than COM.
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Abstract
BACKGROUND Cholesteatoma is widely considered to be more aggressive in children than adults, yet few studies have directly compared the operative findings and surgical outcomes between these two groups. This study aimed to assess differences between childhood and adult cholesteatoma. METHODS The operative caseload of a single consultant surgeon was reviewed between January 2006 and May 2017 using the online Common Otology Audit database. Extracted data were categorised according to patient age (children, aged below 16 years, and adults, aged 16 years or over) and compared. RESULTS This study included data from 71 operations on children and 281 operations on adults, performed for cholesteatoma. Childhood cholesteatoma demonstrated significantly more extension (into the sinus tympani, mastoid antrum and mastoid air cells) and ossicular erosion (of the malleus, incus and stapes superstructure) compared to adults. No significant differences were seen in revision rates, post-operative complications or hearing gain. CONCLUSION Childhood cholesteatoma was more extensive and destructive compared to adults, representing a more aggressive disease in this cohort.
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Richard SA, Qiang L, Lan ZG, Zhang Y, You C. A giant cholesteatoma of the mastoid extending into the foramen magnum: A case report and review of literature. Neurol Int 2018; 10:7625. [PMID: 29844894 PMCID: PMC5937224 DOI: 10.4081/ni.2018.7625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/04/2018] [Indexed: 02/05/2023] Open
Abstract
Cholesteatomas are very rare benign, progressive lesions that have embryologic derivation and usually result in progressive exfoliation and confinement of squamous epithelium behind an intact or preciously infected tympanic membrane. To the best of our understanding no reports demonstrates the extension of cholesteatoma from the temporal bone into the foramen magnum. We therefore present a case of cholesteatoma extending down into the foramen magnum. We report a case of 67- year-old man with a giant cholesteatoma extending into the foramen magnum without substantial destruction of the mastoid and petrous temporal bones. The patient’s major symptoms were recurrent tinnitus in the left ear and dizziness with unilateral conductive hearing loss. A working diagnosis of cholesteatomas was made combining the symptoms and magnetic resonance imaging findings. He was then successfully operated on with very minimal postoperative complications. Cholesteatomas originating from the mastoid bone often linger with the patients for many years in a subclinical state and progress into a massive size before causing symptoms. Patients with unilateral conductive hearing loss who are otherwise asymptomatic and have a normal tympanic membrane should be suspected with a progressive cholesteatoma. Cholesteatoma should be one of the working diagnosis when an elderly patient present with unilateral conductive hearing loss that is associated with tinnitus and dizziness.
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Affiliation(s)
| | - Li Qiang
- Department of Neurosurgery, West China Hospital, Sichuan University, China
| | - Zhi Gang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, China
| | - Yuekang Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, China
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Nakagawa H, Toyoda Y, Albrecht T, Tsukamoto M, Praetorius M, Ishikawa T, Kamiya K, Kusunoki T, Ikeda K, Sertel S. Are human ATP-binding cassette transporter C11 and earwax associated with the incidence of cholesteatoma? Med Hypotheses 2018; 114:19-22. [PMID: 29602456 DOI: 10.1016/j.mehy.2018.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/18/2017] [Accepted: 02/23/2018] [Indexed: 01/17/2023]
Abstract
Cholesteatoma is an ear disease based on a locally destructive noncancerous conglomerate of epidermis and keratin debris. Abnormal growth of stratified keratinized squamous epithelium in the temporal bone causes destruction of the outer and middle ear, potentially leading to hearing impairment, facial palsy, vertigo, lateral sinus thrombosis, and intracranial complications. Although cholesteatoma is effectively treated by surgical resection (mastoidectomy), the lack of effective and nonsurgical therapies potentially results in fatal consequences, establishing the need for a comprehensive investigation of cholesteatoma pathogenesis. Although its etiology is still being debated, interestingly, we found that the trend associated with the 538G allele frequency of the adenosine triphosphate-binding cassette transporter C11 (ABCC11) gene, the determinant of wet-type earwax, and ethnic groups was similar to that between the incidence of cholesteatoma and ethnic groups (countries). The incidences of cholesteatoma in Europe (Denmark, Finland, and Scotland) are higher than in East Asia (Japan), and the frequencies of the ABCC11 538G allele in African, American, and European (Finland and Scotland) populations are higher than those in East Asian populations (Japan). Additionally, a single-nucleotide polymorphism in the ABCC11 gene (rs17822931, 538G > A; Gly180Arg) is closely related to earwax morphotypes. While earwax is often beneficial to ear health, it is sometimes harmful in cases where it causes hearing impairment. Based on independent findings of associations between ABCC11 and the physiological environment of the auditory canal, we hypothesize a possible link between ABCC11, earwax, and the incidence of cholesteatoma.
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Affiliation(s)
- Hiroshi Nakagawa
- Department of Biological Chemistry, College of Bioscience and Biotechnology, Chubu University, 1200 Matsumoto-cho, Kasugai, Aichi 487-8501, Japan; Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Yu Toyoda
- Department of Pharmacy, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tobias Albrecht
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Megumi Tsukamoto
- Department of Biological Chemistry, College of Bioscience and Biotechnology, Chubu University, 1200 Matsumoto-cho, Kasugai, Aichi 487-8501, Japan
| | - Mark Praetorius
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | | | - Kazusaku Kamiya
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Takeshi Kusunoki
- Department of Otorhinolaryngology, Juntendo University of Medicine, Shizuoka Hospital, 1129 Nagaoka Izunokuni-shi, Shizuoka 410-2295, Japan
| | - Katsuhisa Ikeda
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Serkan Sertel
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; HNO Praxis Prof. Sertel, Rottstraße 39, 67061 Ludwigshafen am Rhein, Germany.
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Lingam R, Connor S, Casselman J, Beale T. MRI in otology: applications in cholesteatoma and Ménière's disease. Clin Radiol 2018; 73:35-44. [DOI: 10.1016/j.crad.2017.09.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 09/01/2017] [Indexed: 01/04/2023]
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Nevoux J. [The ear: This organ with two senses!]. Presse Med 2017; 46:1030-1032. [PMID: 29173396 DOI: 10.1016/j.lpm.2017.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jérome Nevoux
- AP-HP, hôpital Bicêtre, service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 94270 Le-Kremlin-Bicêtre, France; Université Paris-Saclay, faculté de médecine, 94275 Le-Kremlin-Bicêtre, France; Inserm U1185, Le-Kremlin-Bicêtre, France.
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Dubernard X, Kleiber JC, Brenet E, Louges MA, Veleine Y, Labrousse M, Makeieff M, Bazin A, Chays A. [The tumors of the ear]. Presse Med 2017; 46:1079-1088. [PMID: 29097033 DOI: 10.1016/j.lpm.2017.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 11/26/2022] Open
Abstract
Any cutaneous lesion of the outer ear must be managed jointly by a dermatologist and an ENT, regardless of the age of the patient. The presence of a malignant cutaneous carcinoma (Squamous cell carcinoma or melanoma) of the pavilion requires a minimum extension assessment by a cervical ultrasound, CT-scan and MRI will be prescribed according to the degree of infiltration and the presence of clinics signs (lymphadenopathy, facial paralysis, cognitive impairment). A polyp of the external auditory meatus must be systematically biopsied in consultation and, if necessary, in the operating room with fresh anatomopathological analysis. Any "otitis externa", which does not progress favorably under local treatment, must lead to eliminate a tumoral pathology of the external acoustic meatus or of the middle ear. Any suspicion of cholesteatoma should lead to an ENT consultation to confirm the diagnosis and consider its treatment to limit the auditory dysfunction. Any unilateral neurosensorial hearing loss or unilateral vestibular involvement with normal otoscopy should lead to eliminate a inner ear tumor by an MRI of the inner ear and the ponto-cerebellar angle in millimeter sections.
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Affiliation(s)
- X Dubernard
- Hôpital Robert-Debré, departement d'oto-rhino-laryngologie, 51100 Reims, France; Université de Reims Champagne-Ardenne, faculté de médecine, 51100 Reims, France.
| | - J-C Kleiber
- Université de Reims Champagne-Ardenne, faculté de médecine, 51100 Reims, France; Hôpital Maison-Blanche, departement de neurochirurgie, 51100 Reims, France
| | - E Brenet
- Hôpital Robert-Debré, departement d'oto-rhino-laryngologie, 51100 Reims, France
| | - M-A Louges
- Hôpital Robert-Debré, departement d'oto-rhino-laryngologie, 51100 Reims, France
| | - Y Veleine
- Hôpital Robert-Debré, departement d'oto-rhino-laryngologie, 51100 Reims, France
| | - M Labrousse
- Hôpital Robert-Debré, departement d'oto-rhino-laryngologie, 51100 Reims, France; Université de Reims Champagne-Ardenne, faculté de médecine, 51100 Reims, France
| | - M Makeieff
- Hôpital Robert-Debré, departement d'oto-rhino-laryngologie, 51100 Reims, France; Université de Reims Champagne-Ardenne, faculté de médecine, 51100 Reims, France
| | - A Bazin
- Hôpital Maison-Blanche, departement de neurochirurgie, 51100 Reims, France
| | - A Chays
- Hôpital Robert-Debré, departement d'oto-rhino-laryngologie, 51100 Reims, France; Université de Reims Champagne-Ardenne, faculté de médecine, 51100 Reims, France
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MDCT of the temporal bone and audiological findings of pediatric acquired cholesteatoma. Eur Arch Otorhinolaryngol 2017; 274:3959-3964. [PMID: 28828536 DOI: 10.1007/s00405-017-4721-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
Abstract
Cholesteatoma is a benign epithelial lesion affecting the middle ear and/or mastoid process, causing otorrhea and hearing loss. Here, we retrospectively evaluated the temporal multidetector computed tomography and audiological findings of acquired cholesteatoma in children. Forty-three patients younger than 18 years old with middle ear acquired cholesteatoma were evaluated with regard to their clinical symptoms, temporal multidetector computed tomography findings, and audiometry results. The multidetector computed tomography findings were classified according to the site-ossicle-complication classification, and the relationships between the clinical, radiological, and audiological findings were evaluated. Only one patient had pars tensa cholesteatoma, and the remaining had attic cholesteatoma. The most common site-ossicles-complication classifications were S4 (acquired cholesteatoma involving four sites), O1 (involving one ossicle), and C0 (no complications), and the most common complaint was hearing loss, followed by otorrhea. There were no statistically significant relationships between the site of involvement and ossicle involvement. In addition, there were no statistically significant differences according to the S classification in either the air conduction or air-bone-gap levels; however, these levels differed statistically significantly with increasing ossicle involvement. Early diagnosis and treatment are essential to prevent hearing loss and serious complications in cases of acquired cholesteatoma. Therefore, it is important to evaluate the temporal multidetector computed tomography and audiological findings to accurately diagnose acquired cholesteatoma in children.
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Bhalla AS, Singh A, Jana M. Chronically Discharging Ears: Evalution with High Resolution Computed Tomography. Pol J Radiol 2017; 82:478-489. [PMID: 29662576 PMCID: PMC5894029 DOI: 10.12659/pjr.901936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/07/2016] [Indexed: 12/28/2022] Open
Abstract
Chronic suppurative otitis media (CSOM) refers to the middle ear inflammation which is clinically characterized by the discharging ear, hearing deficit, fever and otalgia. Although a clinical diagnosis, imaging is imperative to rule out associated complications which apart from causing hearing deficit, may prove fatal at times. Both high resolution computed tomography (HRCT) and MRI are helpful in evaluating middle ear pathologies, usage being indication specific. Due to its excellent spatial resolution, HRCT is invaluable in assessment of chronically discharging ears, especially to look for bone erosion and the integrity of the ossicles. Due to its better spatial resolution, HRCT is preferred in suspected intra temporal complications whereas MRI is more useful in evaluating intracranial extension.
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Affiliation(s)
- Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Anuradha Singh
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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A Meta-Analysis on the Diagnostic Performance of Non-Echoplanar Diffusion-Weighted Imaging in Detecting Middle Ear Cholesteatoma: 10 Years On. Otol Neurotol 2017; 38:521-528. [DOI: 10.1097/mao.0000000000001353] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Thompson LDR. Update From the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumours of the Ear. Head Neck Pathol 2017; 11:78-87. [PMID: 28247225 PMCID: PMC5340731 DOI: 10.1007/s12105-017-0790-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Abstract
The 2017 fourth edition of the World Health Organization Classification of Tumours, specifically as it relates to the ear (Chap. 9), has several changes. Importantly, the number of entities has been significantly reduced by omitting tumors or lesions if they do not occur exclusively or predominantly at this site or if they are discussed in detail elsewhere in the book. These entities include: embryonal rhabdomyosarcoma, osteoma, exostosis, angiolymphoid hyperplasia with eosinophilia, Schneiderian papilloma, inverted papilloma, lipoma of the internal auditory canal, hemangioma, hematolymphoid tumors, and secondary tumors. Paraganglioma was included in the neck chapter. New entries include otosclerosis and cholesteatoma, while refinements to nomenclature, classification and criteria were incorporated into the ceruminous gland tumors and epithelial tumors of the middle and inner ear. Specifically, the middle and inner ear were combined, as practical limitations of origin and imaging make a definitive separation artificial. The classification reflects the state of current understanding for these uncommon entities, with this update only highlighting selected entities that were the most significantly changed.
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Affiliation(s)
- Lester D. R. Thompson
- 0000 0004 0445 0789grid.417224.6Department of Pathology, Southern California Kaiser Permanente Group, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, CA 91365 USA
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Lingam RK, Nash R, Majithia A, Kalan A, Singh A. Non-echoplanar diffusion weighted imaging in the detection of post-operative middle ear cholesteatoma: navigating beyond the pitfalls to find the pearl. Insights Imaging 2016; 7:669-78. [PMID: 27558789 PMCID: PMC5028345 DOI: 10.1007/s13244-016-0516-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 12/19/2022] Open
Abstract
Abstract Non-echoplanar diffusion weighted magnetic resonance imaging (DWI) has established itself as the modality of choice in detecting and localising post-operative middle ear cleft cholesteatoma. Despite its good diagnostic performance, there are recognised pitfalls in its radiological interpretation which both the radiologist and otologist should be aware of. Our article highlights the various pitfalls and provides guidance for improving radiological interpretation and navigating beyond many of the pitfalls. It is recommended radiological practice to interpret the diffusion weighted images together with the ADC map and supplement with the corresponding T1 weighted and T2 weighted images, all of which can contribute to and enhance lesion localisation and characterisation. ADC values are also helpful in improving specificity and confidence levels. Given the limitation in sensitivity in detecting small cholesteatoma less than 3 mm, serial monitoring with DWI over time is recommended to allow any small residual cholesteatoma pearls to grow and become large enough to be detected on DWI. Optimising image acquisition and discussing at a joint clinico-radiological meeting both foster good radiological interpretation to navigate beyond the pitfalls and ultimately good patient care. Teaching Points • Non-echoplanar DWI is the imaging of choice in detecting post-operative cholesteatoma. • There are recognised pitfalls which may hinder accurate radiological interpretation. • Interpret with the ADC map /values and T1W and T2W images. • Serial DWI monitoring is of value in detection and characterisation. • Optimising image acquisition and discussing at clinico-radiological meetings enhance radiological interpretation.
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Affiliation(s)
- Ravi K Lingam
- Department of Radiology, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK.
| | - Robert Nash
- Department of Otolaryngology, Head & Neck Surgery, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK
| | - Anooj Majithia
- Department of Otolaryngology, Head & Neck Surgery, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK
| | - Ali Kalan
- Department of Otolaryngology, Head & Neck Surgery, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK
| | - Arvind Singh
- Department of Otolaryngology, Head & Neck Surgery, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK
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van Hövell Tot Westerflier CVA, van Wijk MP, Kon M. Surgical Correction of the "Sunken Ear": An Auricular Positional Change after Canal Wall Down Mastoidectomy. Otolaryngol Head Neck Surg 2016; 154:1161-3. [PMID: 27143703 DOI: 10.1177/0194599816644589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 03/24/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | - Marieke P van Wijk
- Department of Plastic, Reconstructive and Hand Surgery, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - Moshe Kon
- DutchCenterforEarReconstruction,DepartmentofPlastic,Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Mierzwinski J, Fishman AJ, Grochowski T, Drewa S, Drela M, Winiarski P, Bielecki I. Cochlear implant and congenital cholesteatoma. J Otolaryngol Head Neck Surg 2016; 45:8. [PMID: 26829926 PMCID: PMC4736255 DOI: 10.1186/s40463-016-0119-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The occurence of cholesteatoma and cochlear implant is rare. Secondary cholesteatomas may develop as a result of cochlear implant surgery. Primarily acquired cholesteatoma is not typically associated with congenital sensorineural hearing loss or cochlear implant in children. The occurrence of congenital cholesteatoma during cochlear implant surgery has never been reported before, partly because all patients are preoperatively submitted to imaging studies which can theoretically exclude the disease. CASE PRESENTATION We have reported a rare case of congenital cholesteatoma, found during sequential second side cochlear implantation in a 3-year-old child. The child underwent a computed tomography (CT) scan and magnetic resonance imaging (MRI) at 12 months of age, before the first cochlear implant surgery, which excluded middle ear pathology. The mass was removed as an intact pearl, without visible or microscopic violation of the cholesteatoma capsule. All the areas where middle ear structures were touching the cholesteatoma were vaporized with a laser and the cochlear implant was inserted uneventfully. Further follow-up excluded residual disease. CONCLUSION We believe that primary, single stage placement of a cochlear implant (CI) with simultaneous removal of the congenital cholesteatoma can be performed safely. However, to prevent recurrence, the capsule of the cholesteatoma must not be damaged and complete laser ablation of the surface, where suspicious epithelial cells could remain, is recommended. In our opinion, cholesteatoma removal and cochlear implantation should be staged if these conditions are not met, and/or the disease is at a more advanced stage. It is suspected, that the incidence of congenital cholesteatoma in pediatric CI candidates is much higher that in average pediatric population.
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Affiliation(s)
- J Mierzwinski
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Chodkiewicza 44, 85-667, Bydgoszcz, Poland.
| | - A J Fishman
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Chodkiewicza 44, 85-667, Bydgoszcz, Poland.
| | - T Grochowski
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Chodkiewicza 44, 85-667, Bydgoszcz, Poland.
| | - S Drewa
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Chodkiewicza 44, 85-667, Bydgoszcz, Poland.
| | - M Drela
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Chodkiewicza 44, 85-667, Bydgoszcz, Poland.
| | - P Winiarski
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Bydgoszcz, Ujejskiego 52, 85-168, Bydgoszcz, Poland.
| | - I Bielecki
- Department of Pediatric Otolaryngology, University Children's Hospital of Katowice, ul Medyków 16, 40-752, Katowice, Poland.
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McGuire JK, Wasl H, Harris T, Copley GJ, Fagan JJ. Management of pediatric cholesteatoma based on presentations, complications, and outcomes. Int J Pediatr Otorhinolaryngol 2016; 80:69-73. [PMID: 26746615 DOI: 10.1016/j.ijporl.2015.10.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/26/2015] [Accepted: 10/29/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To highlight important aspects and paradigms in the management of paediatric cholesteatoma in a developing world setting. METHODS A retrospective audit was conducted of paediatric cholesteatomas that underwent tympanomastoid surgery between 2008 and 2012 at the Red Cross War Memorial Children's Hospital in Cape Town. The following was audited: initial presentation; cholesteatoma complications; types of surgery, intraoperative findings and outcomes of surgery in terms of hearing, otorrhoea and recidivism; and the reliability of follow-up and how this might influence the type of surgery. RESULTS Fifty-seven children aged 2-13 years with 61 cholesteatomas (4 bilateral) were reviewed. Fifty-five mastoidectomies were done; 11% presented with complicated cholesteatoma. Referrals from primary care were significantly delayed (>6 months) in 76%. Canal wall down surgery was done in 71%. Forty-five percent had improved hearing (within 15dB of better hearing ear) and a further 15% had no or only mild hearing loss. Ossicular chain involvement and ossicles encased in inflammatory tissue were associated with poorer hearing outcomes. Sixty-four percent of ears remained dry. Forty-five percent of the canal wall up, and 23% of canal wall down mastoidectomies had recidivism. Twenty-six percent of patients were lost to follow-up. CONCLUSIONS Children are likely to present with advanced cholesteatoma with ossicular chain involvement. The children present with high rates of complications, poor pre-operative hearing and have high recurrence rates post-surgery. Referral from primary health care is delayed. Canal wall down procedures may be appropriate in a setting where patient follow-up is unreliable and access to operating theatre is limited.
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Affiliation(s)
- J K McGuire
- Division of Otolaryngology, University of Cape Town Medical School, Cape Town, South Africa.
| | - H Wasl
- Division of Otolaryngology, University of Cape Town Medical School, Cape Town, South Africa
| | - T Harris
- Division of Otolaryngology, University of Cape Town Medical School
| | - G J Copley
- Paediatric Otolaryngology, Red Cross Children's Hospital, Division of Otolaryngology, University of Cape Town Medical School, Cape Town, South Africa
| | - J J Fagan
- Head of Otolaryngology, University of Cape Town, Cape Town, South Africa
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Lee CH, Kim JY, Kim YJ, Yoo CK, Kim HM, Ahn JC. Transcanal CO2 laser-enabled ablation and resection (CLEAR) for intratympanic membrane congenital cholesteatoma. Int J Pediatr Otorhinolaryngol 2015; 79:2316-20. [PMID: 26602555 DOI: 10.1016/j.ijporl.2015.10.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/23/2015] [Accepted: 10/26/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Cholesteatoma in the tympanic membrane is frequently regarded as congenital but there has been no case series review or comparison study with typical pediatric congenital cholesteatoma (CC). METHODS All pediatric CC cases from 2009 to 2014 were collected, and a total of 10 cases of intratymapnic membrane CC (ICC) out of 429 CC cases were reviewed. They were compared with 14 cases of iatrogenic intratympanic membrane keratin after pediatric CC surgery (IIKC). RESULTS ICC constituted 2.3% (10/429) of CCs, and the median age of operation was 24 months, 12 months earlier than that for CC. ICC failed to show male preference which is found in both CC and IIKC. As CC is commonly abutting the medial side of malleus, almost 90% of ICCs were found abutting the umbo of malleus. However, IIKC was usually located at the epithelial trauma site during the CC surgery without malleus abutment. Except in case of spontaneous resolution, the other cases of ICC and IIKC were treated by minimally invasive transcanal CO2 laser-enabled ablation and resection (CLEAR) alleviating any ossicle vibration trauma, incision or graft harvest. All patients retained normal hearing without complication and recurrence. CONCLUSION ICC might be a rare variant of early detectable pediatric CC estimated from its location close to the ossicle and the surgical findings, but without sex preference. Although ICC shares morphologic similarity with IIKC, their locations of development are different, thereby suggesting different pathogenesis rather than epithelial injury. However, CLEAR surgery can be a good treatment option for intratympanic membrane lesions.
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Affiliation(s)
- Chang-Ho Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Ji Yoon Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Young Ju Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Chan Kee Yoo
- Department of Otorhinolaryngology - Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Hyoung-Mi Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jae-Cheul Ahn
- Department of Otorhinolaryngology - Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
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Nash R, Wong PY, Kalan A, Lingam RK, Singh A. Comparing diffusion weighted MRI in the detection of post-operative middle ear cholesteatoma in children and adults. Int J Pediatr Otorhinolaryngol 2015; 79:2281-5. [PMID: 26547234 DOI: 10.1016/j.ijporl.2015.10.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/17/2015] [Accepted: 10/21/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There is a limited evidence base for the use of diffusion weighted MRI (DWMRI) in the assessment of post-operative cholesteatoma in children. This is important to address as this technique is particularly relevant in a paediatric setting. METHODS We searched a prospectively collected database of patients undergoing DWMRI for the assessment of residual and recurrent cholesteatoma. Imaging findings were correlated with findings at revision surgery. 320 investigations were divided into paediatric and adult groups (90 in children, 230 in adults) and compared. RESULTS Operative findings were available for 158 cases, of which 54 were children. The accuracy of DWMRI in children was 96.3%, and in adults was 88.5%. There were no statistically significant differences in the sensitivity, specificity, positive or negative predictive values between adults and children. DISCUSSION An increasing number of patients are not undergoing confirmatory surgery after negative DWMRI scans. False negative results are commonly secondary to small foci of disease; false positives have several possible causes. Performing MRI on children can be challenging, but sedation may be helpful in younger children. CONCLUSION The performance of diffusion weighted MRI is similar in paediatric and adult settings. This study suggests that DWMRI may be used in clinical practice in a similar way in children and adults.
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Affiliation(s)
- Robert Nash
- Department of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom
| | - Phui Yee Wong
- Department of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom
| | - Ali Kalan
- Department of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom
| | - Ravi K Lingam
- Department of Radiology, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom.
| | - Arvind Singh
- Department of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom
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Lecler A, Lenoir M, Peron J, Denoyelle F, Garabedian EN, Pointe HDL, Nevoux J. Magnetic resonance imaging at one year for detection of postoperative residual cholesteatoma in children: Is it too early? Int J Pediatr Otorhinolaryngol 2015; 79:1268-74. [PMID: 26071017 DOI: 10.1016/j.ijporl.2015.05.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/16/2015] [Accepted: 05/19/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare the residual cholesteatoma detection accuracy of diffusion-weighted (DW) and T1 delayed sequences for magnetic resonance at one year postoperative with second-look surgery in pediatric patients who have undergone primary middle ear surgery for cholesteatoma. METHODS This was a prospective monocentric consecutive study conducted in a tertiary academic referral center. Children were referred for MR imaging (MRI) one year after surgery. A 1.5T MRI was utilized, using nonecho-planar DW images and delayed gadolinium-enhanced T1-weighted images. Accuracy of magnetic resonance imaging was assessed by two radiologists before surgery. Interobserver and intraobserver agreements were assessed using the κ test. Magnetic resonance imaging data were compared with surgery, which was considered as the gold standard. RESULTS Twenty-four consecutive unselected pediatric patients were included. Sensitivity, specificity, positive predictive value, and negative predictive value for the first observer were of 40%, 86%, 67%, and 67%, respectively, and those for the second observer were 30%, 86%, 60%, and 63%, respectively. The only two cholesteatoma with a size superior to 3mm were diagnosed before surgery, but the majority of small cholesteatoma were not detected. CONCLUSIONS MRI is a key examen to diagnosed the residual cholesteatoma but is limited by the size of the lesion under 3mm. Delaying the realization of MRI during follow-up could increase sensitivity, thus avoiding misdiagnosis as well as unnecessary second look surgery.
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Affiliation(s)
- A Lecler
- Service de Radiologie pédiatrique, Hôpital Trousseau, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, 26 avenue du docteur Arnold Netter, 75012 Paris, France; Service de Neuroradiologie diagnostique, Fondation Rothschild, 25 rue Manin, 75019 Paris, France.
| | - M Lenoir
- Service de Radiologie pédiatrique, Hôpital Trousseau, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, 26 avenue du docteur Arnold Netter, 75012 Paris, France
| | - J Peron
- Centre anticancéreux Léon Bérard, Oncologie Médicale, 28 rue Laennec, 69008 Lyon, France
| | - F Denoyelle
- Service d'Oto-Rhino-Laryngologie pédiatrique, Hôpital Necker, Université Paris René Descartes, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France
| | - E N Garabedian
- Service d'Oto-Rhino-Laryngologie pédiatrique, Hôpital Necker, Université Paris René Descartes, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France
| | - H Ducou le Pointe
- Service de Radiologie pédiatrique, Hôpital Trousseau, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, 26 avenue du docteur Arnold Netter, 75012 Paris, France
| | - J Nevoux
- Service d'Oto-Rhino-Laryngologie, INSERM U1185, Hôpital Bicêtre, Université Paris Sud, Assistance Publique Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
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von Kalle T, Amrhein P, Koitschev A. Non-echoplanar diffusion-weighted MRI in children and adolescents with cholesteatoma: reliability and pitfalls in comparison to middle ear surgery. Pediatr Radiol 2015; 45:1031-8. [PMID: 25676040 DOI: 10.1007/s00247-015-3287-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 10/12/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Currently, there is only limited and contradictory evidence of the role of diffusion-weighted MRI (DW-MRI) in the management of children with cholesteatoma. OBJECTIVE To provide surgically controlled data that may allow to replace second-look surgery by non-echoplanar DW-MRI in children. MATERIALS AND METHODS Fifty-five children and adolescents with a median age of 8.6 years (2.2-17.7 years) underwent 61 preoperative half-Fourier acquisition single-shot turbo spin-echo (HASTE) DW-MRI of their petrous bone. Surgical interventions followed within 24 h (79%), within 5 months (20%) or at 18 months (1 case). RESULTS Surgery detected a cholesteatoma or retraction pocket in 41 of 61 cases (67%). In 49 cases (80%), the MR result was confirmed by surgical findings. Two MR findings were false-positive and 10 false-negative (including cholesteatomas <4 mm). HASTE DW-MRI alone had a sensitivity of 76% and a specificity of 90%. The positive predictive value was 94%, the negative predictive value 64%. In combination with preoperative otoscopy, sensitivity was 90% and negative predictive value 82%. CONCLUSION DW-MRI correctly detected the majority of lesions but could not reliably exclude small cholesteatomas and empty retraction pockets. We would therefore not generally recommend MR as a substitute for second-look surgery.
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Affiliation(s)
- Thekla von Kalle
- Pediatric Radiology, Radiologisches Institut, Olgahospital Klinikum Stuttgart, Kriegsbergstr. 62, D-70174, Stuttgart, Germany,
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Pediatric middle ear cholesteatoma: the comparative study of congenital cholesteatoma and acquired cholesteatoma. Eur Arch Otorhinolaryngol 2015; 273:1155-60. [DOI: 10.1007/s00405-015-3679-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
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Kopcsányi G, Vincze O, Bagdán V, Pytel J. Retrospective analysis of tympanoplasty in children with cleft palate: a 24-year experience. II. Cholesteatomatous cases. Int J Pediatr Otorhinolaryngol 2015; 79:698-706. [PMID: 25758198 DOI: 10.1016/j.ijporl.2015.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Contradictory experience has been published on the outcomes of ear surgery in patients with cleft palate. OBJECTIVES The authors of this study investigated whether there were differences in the short- and long-term outcomes of tympanoplasty performed due to cholesteatoma in children with or without cleft palate. SETTING Tertiary care medical centre. METHODS The authors retrospectively analyzed the first author's 24-year experience of paediatric tympanoplasty using the software programme developed by the fourth author. The outcomes of 268 tympanoplasties on 172 ears with cholesteatoma in 151 'NoCleft' patients were compared to the outcomes of 35 tympanoplasties on 20 ears of 19 'Cleft' patients. The average age of the patients was 10.7±3.6 years and 9.5±2.7 years respectively. The average follow-up time was 4 and 4.1 years. RESULTS Preoperative PTA-ABGs (31.22/34.88 dB; p=0.058), best postoperative PTA-ABGs (17.04/16.4 dB; p=0.499), last postoperative PTA-ABGs (19.93/20.98 dB; p=0.298), the final hearing improvement (11.29/13.9 dB; p=0.193) and postoperative PTA-ABG deterioration with time (2.89/4.58 dB; p=0.117) were statistically compared between the 'NoCleft' and 'Cleft' groups. The same parameters were analyzed separately in the case of tympanoplasty performed with intact ossicular chain and the different type of columella ossiculoplasty. No significant differences were found between the two groups in any of these parameters. However, significant difference was found in the necessity for grommet insertion (8-fold difference, p≈0), and conversion to open techniques (p≈0). CONCLUSIONS The authors conclude that the achievable audiological outcomes of tympanoplasty in children with cleft palate and cholesteatoma do not differ significantly from those of the general child population. However, this more frequently requires ventilation tube insertion and more frequent follow-up visits. The latter is ensured by patient care within the frameworks of the 'Cleft Palate Team'. We have to accept that in some cases Eustachian tube dysfunction caused by the underlying disease (cleft palate) 'takes over' and we have to resort to open techniques.
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Affiliation(s)
- Gábor Kopcsányi
- Department of Pediatrics, University of Pécs Medical School, Pécs, Hungary.
| | - Olga Vincze
- Department of Pediatrics, University of Pécs Medical School, Pécs, Hungary
| | - Viktor Bagdán
- Pollack Mihaly Faculty of Engineering and Information Technology, University of Pécs, Hungary
| | - József Pytel
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pécs Medical School, Pécs, Hungary
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Updates and knowledge gaps in cholesteatoma research. BIOMED RESEARCH INTERNATIONAL 2015; 2015:854024. [PMID: 25866816 PMCID: PMC4381684 DOI: 10.1155/2015/854024] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 12/15/2022]
Abstract
The existence of acquired cholesteatoma has been recognized for more than three centuries; however, the nature of the disorder has yet to be determined. Without timely detection and intervention, cholesteatomas can become dangerously large and invade intratemporal structures, resulting in numerous intra- and extracranial complications. Due to its aggressive growth, invasive nature, and the potentially fatal consequences of intracranial complications, acquired cholesteatoma remains a cause of morbidity and death for those who lack access to advanced medical care. Currently, no viable nonsurgical therapies are available. Developing an effective management strategy for this disorder will require a comprehensive understanding of past progress and recent advances. This paper presents a brief review of background issues related to acquired middle ear cholesteatoma and deals with practical considerations regarding the history and etymology of the disorder. We also consider issues related to the classification, epidemiology, histopathology, clinical presentation, and complications of acquired cholesteatoma and examine current diagnosis and management strategies in detail.
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Infectious causes of cholesteatoma and treatment of infected ossicles prior to reimplantation by hydrostatic high-pressure inactivation. BIOMED RESEARCH INTERNATIONAL 2015; 2015:761259. [PMID: 25705686 PMCID: PMC4330946 DOI: 10.1155/2015/761259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/20/2015] [Indexed: 11/26/2022]
Abstract
Chronic inflammation, which is caused by recurrent infections, is one of the factors contributing to the pathogenesis of cholesteatoma. If reimplantation of autologous ossicles after a surgical intervention is intended, inactivation of planktonic bacteria and biofilms is desirable. High hydrostatic pressure treatment is a procedure, which has been used to inactivate cholesteatoma cells on ossicles. Here we discuss the potential inactivating effect of high hydrostatic pressure on microbial pathogens including biofilms. Recent experimental data suggest an incomplete inactivation at a pressure level, which is tolerable for the bone substance of ossicles and results at least in a considerable reduction of pathogen load. Further studies are necessary to access how far this quantitative reduction of pathogens is sufficient to prevent ongoing chronic infections, for example, due to forming of biofilms.
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Minovi A, Dazert S. Diseases of the middle ear in childhood. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc11. [PMID: 25587371 PMCID: PMC4273172 DOI: 10.3205/cto000114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Middle ear diseases in childhood play an important role in daily ENT practice due to their high incidence. Some of these like acute otitis media or otitis media with effusion have been studied extensively within the last decades. In this article, we present a selection of important childhood middle ear diseases and discuss the actual literature concerning their treatment, management of complications and outcome. Another main topic of this paper deals with the possibilities of surgical hearing rehabilitation in childhood. The bone-anchored hearing aid BAHA(®) and the active partially implantable device Vibrant Soundbridge(®) could successfully be applied for children. In this manuscript, we discuss the actual literature concerning clinical outcomes of these implantable hearing aids.
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Affiliation(s)
- Amir Minovi
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany
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Muranjan M, Karande S, Parikh S, Sankhe S. A mistaken identity: rhabdomyosarcoma of the middle ear cleft misdiagnosed as chronic suppurative otitis media with temporal lobe abscess. BMJ Case Rep 2014; 2014:bcr-2014-206615. [PMID: 25240007 DOI: 10.1136/bcr-2014-206615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
A 5-year-old girl presented with a 3-month history of left side facial palsy, followed sequentially by purulent ear discharge, complete external ophthalmoplaegia and blurred vision. On clinical examination she was febrile with left-sided conductive hearing loss. She was clinically diagnosed to have chronic suppurative otitis media of the unsafe type with petrous apicitis, middle cranial fossa abscess and cavernous sinus involvement. Preliminary CT scan findings were reported as a large left temporal lobe abscess and left otitis media with cholesteatoma. MRI of the brain obtained later corroborated the abnormalities detected on the CT scan. Ten days after admission, a mass was seen protruding from the external auditory canal. A biopsy of the mass was obtained and sent for histopathological examination. Meanwhile, review of the MRI suggested an aggressive neoplasm such as sarcoma/rhabdomyosarcoma. Histopathology clinched the final diagnosis of an anaplastic type of embryonal rhabdomyosarcoma of the middle ear cleft.
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Affiliation(s)
- Mamta Muranjan
- Department of Pediatrics, Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India
| | - Sunil Karande
- Department of Pediatrics, Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India
| | - Shefali Parikh
- Department of Pediatrics, Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India
| | - Shilpa Sankhe
- Department of Radiology, Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India
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