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Vangrinsven G, Bernaerts A, Deckers F, van Dinther J, Zarowski A, De Foer B. Beyond the otoscope: an imaging review of congenital cholesteatoma. Insights Imaging 2024; 15:194. [PMID: 39112725 PMCID: PMC11306902 DOI: 10.1186/s13244-024-01761-1] [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: 03/20/2024] [Accepted: 06/22/2024] [Indexed: 08/10/2024] Open
Abstract
Congenital cholesteatoma (CC) is a non-neoplastic lesion of keratin debris lined by epithelium found in the temporal bone. It is the lesser-known sibling of the acquired cholesteatoma and may be classified as congenital middle ear cholesteatoma and congenital petrous bone cholesteatoma. The incidence is rising, probably owing to increased recognition and advances in imaging modalities. Cone beam CT provides detailed anatomical information, highlighting quadrant location, ossicular involvement, and mastoid extension. MRI aids in lesion characterization and detection of complications. The classification systems for congenital middle ear and petrous bone cholesteatoma are helpful in the preoperative workup and have a role in predicting postoperative recurrence rates. Management almost invariably involves surgical intervention aimed at preserving middle and inner ear function. Follow-up of CC is mainly based on MRI together with otoscopic examination. Non-echo planar diffusion-weighted imaging, especially, has proven essential for detecting residual disease. This review article emphasizes the significance of imaging in the timely diagnosis and management of CCs. CLINICAL RELEVANCE STATEMENT: This article underscores the crucial role of imaging for prompt detection, preoperative assessment, and postoperative follow-up of CCs, a condition with rising incidence associated with potentially severe complications. KEY POINTS: Timely diagnosis of CCs is imperative for avoiding complications. Imaging is key in detection, preoperative evaluation, and postoperative management. Cone Beam CT and non-echo planar DWI represent state-of-the-art imaging techniques.
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Affiliation(s)
- Guillaume Vangrinsven
- Departement of Radiology, ZAS Hospitals, Antwerp, Belgium.
- Departement of Radiology, Antwerp University Hospital, Antwerp, Belgium.
| | - Anja Bernaerts
- Departement of Radiology, ZAS Hospitals, Antwerp, Belgium
| | - Filip Deckers
- Departement of Radiology, ZAS Hospitals, Antwerp, Belgium
| | | | | | - Bert De Foer
- Departement of Radiology, ZAS Hospitals, Antwerp, Belgium
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Cheng TC, Ho CY, Wu JL. The role of planned two-stage surgery in the management of congenital cholesteatoma. Int J Pediatr Otorhinolaryngol 2023; 171:111641. [PMID: 37392478 DOI: 10.1016/j.ijporl.2023.111641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE The purpose of this study is to verify the role of "planned two-stage surgery" in the management of advanced congenital cholesteatoma regarding disease recurrence rates, complications and the need for salvage surgery. METHOD Retrospective review of all congenital cholesteatoma under the age of 18 years underwent surgery from October 2007 to December 2021 in a single tertiary referral center. Patients with Potsic stage I/II who had closed-type congenital cholesteatoma received one-stage surgery. Advanced cases or those with open-type infiltrative congenital cholesteatomas underwent planned two-stage surgery. The second stage of surgery was performed 6-10 months after the first stage of surgery. Ossiculoplasty would be performed in the second operation if a significant air-bone gap was detected in the preoperative pure-tone audiometry test. RESULTS Twenty-four patients were included in the series. Six patients received one-stage surgery and no recurrence was noted in this group. The remaining 18 underwent planned two-stage surgery. Residual lesions found in the second operative phase were observed in 39% of patients who received planned two-stage surgery. Except for one patient whose ossicular replacement prosthesis protruded and two patients who had perforated tympanic membranes, none of the 24 patients required salvage surgery during follow-up (mean, 77 months after surgery), and no major complications occurred. CONCLUSIONS Planned two-stage surgery for advanced-stage or open infiltrative congenital cholesteatoma could timely detect residual lesions to avoid extensive surgery and reduce complications.
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Affiliation(s)
- Tsun-Chih Cheng
- Department of Otolaryngology, An Nan Hospital, China Medical University, No.66, Sec. 2, Changhe Rd., Annan Dist., Tainan City, 709, Taiwan.
| | - Cheng-Yu Ho
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, North District, Tainan City, 704, Taiwan.
| | - Jiunn-Liang Wu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, North District, Tainan City, 704, Taiwan.
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Teranishi Y, Koda Y, Kajimoto Y, Oishi M, Sunami K. A Case of a Congenital Cholesteatoma Without Growth for a Long Term. Cureus 2023; 15:e40945. [PMID: 37366477 PMCID: PMC10290909 DOI: 10.7759/cureus.40945] [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] [Accepted: 06/23/2023] [Indexed: 06/28/2023] Open
Abstract
Congenital cholesteatoma is typically an expanding cystic mass of keratinizing squamous epithelium located medial to the intact tympanic membrane in patients with no prior history of perforation, otorrhea and ear. It is generally thought to be a progressive disease and is usually surgically removed upon detection as the first-choice treatment. As such, it is rare to be observed for a long term without progression. Here we report a rare case of congenital cholesteatoma that remained in an undetectable size and did not deteriorate mild hearing loss for 12 years. A seven years old boy was referred to us with right hearing impairment. Pure-tone audiometry found conductive hearing loss with an air-bone gap of 25 dB and a high-resolution computed tomography (CT) scan found the eroded long process of incus but did not detect any soft tissue density indicating congenital cholesteatoma. He initially did not wish to undergo surgery. His hearing level and image finding remained virtually unchanged during the next 12 years of the follow-up period. Twelve years later, endoscopic ear surgery was performed, which revealed a very small cholesteatoma mass, an eroded long process of the incus and ossicular chain discontinuities. We suspect that the cholesteatoma was originally larger, partially eroded the incus, then regressed to a very small size, and remained small for at least 12 years under our observation.
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Affiliation(s)
- Yuichi Teranishi
- Otolaryngology - Head and Neck Surgery, Osaka Metropolitan University, Osaka, JPN
| | - Yuki Koda
- Otolaryngology - Head and Neck Surgery, Osaka Metropolitan University, Osaka, JPN
| | - Yasuyuki Kajimoto
- Otolaryngology - Head and Neck Surgery, Osaka Metropolitan University, Osaka, JPN
| | - Masaya Oishi
- Otolaryngology - Head and Neck Surgery, Osaka Metropolitan University, Osaka, JPN
| | - Kishiko Sunami
- Otolaryngology - Head and Neck Surgery, Osaka Metropolitan University, Osaka, JPN
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Choi JE, Kang WS, Lee JD, Chung JW, Kong SK, Lee IW, Moon IJ, Hur DG, Moon IS, Cho HH. Outcomes of Endoscopic Congenital Cholesteatoma Removal in South Korea. JAMA Otolaryngol Head Neck Surg 2023; 149:231-238. [PMID: 36656575 PMCID: PMC9857717 DOI: 10.1001/jamaoto.2022.4660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/22/2022] [Indexed: 01/20/2023]
Abstract
Importance Transcanal endoscopic ear surgery (TEES) provides minimally invasive transcanal access to the middle ear and improves middle ear visibility during cholesteatoma resection. However, the literature on outcomes following TEES alone for the removal of congenital cholesteatoma (CC) is lacking and limited to small series. Objective To assess outcomes of TEES for CC limited to the middle ear and/or mastoid antrum and to explore the risk factors associated with recidivism (ie, recurrent and/or residual cholesteatoma). Design, Setting, and Participants This cohort study evaluated retrospective, multicenter data for 271 children with CC who underwent TEES at 9 tertiary referral hospitals in South Korea between January 1, 2013, and December 31, 2021, and had a follow-up of at least 6 months after surgery. Main Outcomes and Measures Outcomes included the incidence of residual cholesteatoma and audiometric data after TEES. A multivariable analysis using Cox proportional hazards regression models was used to assess associations between cholesteatoma characteristics and recidivism, with hazard ratios (HRs) and 95% CIs reported. Results Of the 271 patients (mean [SD] age, 3.5 [2.9] years; 194 [71.6%] boys, 77 [28.4%] girls), 190 had Potsic stage I CC (70.1%), 21 (7.7%) had stage II, 57 (21.0%) had stage III, and 3 (1.1%) had stage IV. Thirty-six patients (13.3%) with residual cholesteatoma were found, including 15 (7.9%) with Potsic stage I, 3 (14.3%) with stage II, and 18 (31.6%) with stage III. In the multivariable analysis, invasion of the malleus (HR, 2.257; 95% CI, 1.074-4.743) and posterosuperior quadrant location (HR, 3.078; 95% CI, 1.540-6.151) were associated with the incidence of recidivism. Overall, hearing loss (>25 dB on auditory behavioral test or >30 dB of auditory evoked responses) decreased from 24.4% to 17.7% after TEES. Conclusions and Relevance This cohort study involved the largest known population to date of CC removed by TEES. The findings suggest that TEES may be feasible and effective for the removal of CC limited to the middle ear and/or mastoid antrum in children.
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Affiliation(s)
- Ji Eun Choi
- Department of Otorhinolaryngology–Head and Neck Surgery, Dankook University Hospital, Cheonan, South Korea
| | - Woo Seok Kang
- Department of Otorhinolaryngology–Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong Dae Lee
- Department of Otorhinolaryngology–Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology–Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology–Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Il-Woo Lee
- Department of Otorhinolaryngology–Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Il Joon Moon
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong Gu Hur
- Department of Otorhinolaryngology, Gyeongsang National University Changwon Hospital, College of medicine, Gyeongsang National University, Changwon, South Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyong Ho Cho
- Department of Otolaryngology–Head and Neck Surgery, Chonnam National University Medical School, Gwangju, South Korea
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Jenks CM, Purcell PL, Federici G, Villari D, Presutti L, James AL, Hoff SR. Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma: A Multi-institutional Series. Otolaryngol Head Neck Surg 2021; 167:537-544. [PMID: 34932403 DOI: 10.1177/01945998211067502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess outcomes of transcanal endoscopic ear surgery (TEES) for congenital cholesteatoma. STUDY DESIGN Case series with chart review of children who underwent TEES for congenital cholesteatoma over a 10-year period. SETTING Three tertiary referral centers. METHODS Cholesteatoma extent was classified according to Potsic stage; cases with mastoid extension (Potsic IV) were excluded. Disease characteristics, surgical approach, and outcomes were compared among stages. Outcomes measures included residual or recurrent cholesteatoma and audiometric data. RESULTS Sixty-five cases of congenital cholesteatoma were included. The mean age was 6.5 years (range, 1.2-16), and the mean follow-up was 3.9 years (range, 0.75-9.1). There were 19 cases (29%) of Potsic stage I disease, 10 (15%) stage II, and 36 (55%) stage III. Overall, 24 (37%) patients underwent a second-stage procedure, including 1 with Potsic stage II disease (10%) and 21 (58%) with Potsic stage III disease. Eight cases (12%) of residual cholesteatoma occurred. One patient (2%) developed retraction-type ("recurrent") cholesteatoma. Recidivism occurred only among Potsic stage III cases. Postoperative air conduction hearing thresholds were normal (<25 dB HL) in 93% of Potsic stage I, 88% of stage II, and 36% of stage III cases. CONCLUSION TEES is feasible and effective for removal of congenital cholesteatoma not extending into the mastoid. Recidivism rates were lower with the TEES approach in this large series than in previously reported studies. Advanced-stage disease was the primary risk factor for recidivism and worse hearing result. As minimally invasive TEES is possible in the youngest cases, children benefit from early identification and intervention.
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Affiliation(s)
- Carolyn M Jenks
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patricia L Purcell
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Gaia Federici
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Domenico Villari
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Otolaryngology-Head and Neck Surgery, University Hospital of Bologna, Bologna, Italy
| | - Adrian L James
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Stephen R Hoff
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Division of Otolaryngology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Association of Matrix Metalloproteinase-2 mRNA Expression with Subtypes of Pediatric Cholesteatoma. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6644897. [PMID: 33778077 PMCID: PMC7972836 DOI: 10.1155/2021/6644897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022]
Abstract
Objective Cholesteatoma is a clinically heterogeneous disease, with some patients showing spontaneous regression, while others experiencing an aggressive, lethal disease. Cholesteatoma in children can be divided into two types: congenital and acquired. Identifying good prognostic markers is needed to help select patients who will require immediate surgical intervention. Matrix metalloproteinase-2 (MMP2) was previously reported to play an important role in cholesteatoma progression, by promoting bone destruction and keratinocyte infiltration. Herein, we analyzed MMP2 mRNA expression level in cholesteatoma using RNA-in situ hybridization in formalin-fixed, paraffin-embedded (FFPE) tissue samples. Methods Sixty patients with cholesteatoma under 15 years old, who underwent their primary surgery at Aichi Medical University's Otolaryngology Department, were analyzed for MMP2 expression level, using RNA-in situ hybridization. Results There were no significant differences in MMP2 mRNA expression level between congenital cholesteatoma and acquired cholesteatomas. In congenital cholesteatoma, higher MMP2 signals were observed in the open type than in the closed type (p < 0.001). In acquired cholesteatoma, higher MMP2 signals were observed in the pars tensa than in the pars flaccida (p < 0.001). MMP2 mRNA expression level was almost exclusively found in the fibroblasts or in the inflammatory cells in the stroma, but not in the epithelium. Conclusion Our study reveals that MMP2 mRNA expression level is strongly associated with the subtypes of cholesteatoma. The findings suggest that the level of expression of MMP2 mRNA may be related to the pathogenesis and aggressive features of cholesteatoma.
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Kim HC, Yang HC, Cho HH. Endoscopic Surgery of Congenital Cholesteatoma in the Anterior Epitympanic Recess: A Case Report of a Rare Location. EAR, NOSE & THROAT JOURNAL 2020; 101:677-679. [PMID: 33314962 DOI: 10.1177/0145561320969249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Congenital cholesteatoma is a whitish mass in the middle ear medial to an intact tympanic membrane. It is often without symptoms and therefore incidentally diagnosed. Pediatric congenital cholesteatoma generally starts as a small pearl-like mass in the middle ear cavity that eventually expands to involve the ossicles, epitympanum, and mastoid. The location, size, histopathological type, and extent of the mass must be evaluated to select the appropriate surgical method. Although microscopic ear surgery has traditionally been performed to remove congenital cholesteatoma, a recently introduced alternative is endoscopic surgery, which allows a minimally invasive approach and has better visualization. Here, we report the first known case of a patient with congenital cholesteatoma in the anterior epitympanic recess and discuss the utility of an endoscopic approach in the removal of a congenital cholesteatoma in the hidden area within the middle ear.
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Affiliation(s)
- Hong Chan Kim
- Department of Otolaryngology-Head and Neck Surgery, 65416Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, 65416Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Hyong-Ho Cho
- Department of Otolaryngology-Head and Neck Surgery, 65416Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
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Song IS, Han WG, Lim KH, Nam KJ, Yoo MH, Rah YC, Choi J. Clinical Characteristics and Treatment Outcomes of Congenital Cholesteatoma. J Int Adv Otol 2020; 15:386-390. [PMID: 31846916 DOI: 10.5152/iao.2019.6279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Since its introduction in 2002, the staging system for congenital cholesteatoma, as defined by Potsic, has been used widely owing to its simplicity and predictability. The aim of the present study was to analyze the clinical characteristics and surgical treatment outcomes of congenital cholesteatoma and to correlate them with postoperative recurrence. MATERIALS AND METHODS A retrospective chart review was performed for 38 patients who were diagnosed with congenital cholesteatoma and who underwent surgical resection between August 2007 and November 2014 at the Department of Otorhinolaryngology of our hospital. RESULTS The mean age of the patients was 7.9±8.2 years, and the number of males and females was 20 and 18, respectively. The mean follow-up period was 30±26 months. Of the 38 patients, 9 (24%) had residual or recurrent cholesteatoma during follow-up examination after primary surgery. The results showed that the size (≥4 mm) of the lesion was significantly correlated with residual or recurrent disease (p=0.026). The disease extent (single vs. multiple quadrant involvement), type (closed vs. open type), and stage; applied surgical method (with mastoidectomy vs. without mastoidectomy); and preoperative hearing level (normal vs. abnormal) were not significantly correlated with residual or recurrent disease. CONCLUSION The disease extent, type, and stage; applied surgical methods; and preoperative hearing level were not significantly correlated with residual or recurrent disease. The size (≥4 mm) of congenital cholesteatoma was significantly correlated with residual or recurrent disease.
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Affiliation(s)
- In Sik Song
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University School of Medicine, Ansan-city, Korea, Republic Of
| | - Won Gue Han
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University School of Medicine, Ansan-city, Korea, Republic Of
| | - Kang Hyeon Lim
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University School of Medicine, Ansan-city, Korea, Republic Of
| | - Kuk Jin Nam
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University School of Medicine, Ansan-city, Korea, Republic Of
| | - Myung Hoon Yoo
- Department of Otorhinolaryngology Head and Neck Surgery, Kyungpook National University School of Medicine, Daegu, Korea, Republic Of
| | - Yoon Chan Rah
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University School of Medicine, Ansan-city, Korea, Republic Of
| | - June Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University School of Medicine, Ansan-city, Korea, Republic Of
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Middle ear congenital cholesteatoma: systematic review, meta-analysis and insights on its pathogenesis. Eur Arch Otorhinolaryngol 2020; 277:987-998. [PMID: 31955213 DOI: 10.1007/s00405-020-05792-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/07/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Congenital cholesteatoma (CC) presents as a white pearl-like lesion behind a normal tympanic membrane (TM), without a history of otorrhea, infection, perforation or previous otologic surgery. Several recent studies provided new data improving this pathology characterization. The aim of this paper is to expand the knowledge about CC and to provide new insights on its pathogenesis. METHODS The study consisted of two main research parts: (1) systematic review and meta-analysis; (2) medical literature review englobing anatomy, histology, embryology and congenital pathology of the ear. RESULTS The search strategy identified a total of 636 papers. Seventy retrospective studies were included. A total of 1497 cases were studied and the mean age was 6.58 years, with a male-female ratio of 3:1, 34% were asymptomatic, 26% had hearing loss and 2% had facial dysfunction/paralysis. The overall estimate for antero-superior quadrant involvement was 0.70 [95% confident interval (CI) 0.64-0.76], in the postero-superior quadrant was 0.60 (95% CI 0.52-0.69), in the antero-inferior quadrant was 0.32 (95% CI 0.23-0.41), in the postero-inferior quadrant was 0.38 (95% CI 0.29-0.47), in the attic was 0.53 (95% CI 0.43-0.63) and in the mastoid was 0.33 (95% CI 0.26-0.41). More advanced Potsic stages were present in older patients. The most likely inclusion place seems to be between the pars flaccida and the upper quadrants of the pars tensa. CONCLUSIONS During the last decades, a substantial improvement in CC diagnosis and management had been achieved. The presented mechanism seems to explain most of middle ear CC.
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Morita Y, Tono T, Sakagami M, Yamamoto Y, Matsuda K, Komori M, Hato N, Hashimoto S, Takahashi H, Kojima H. Nationwide survey of congenital cholesteatoma using staging and classification criteria for middle ear cholesteatoma proposed by the Japan Otological Society. Auris Nasus Larynx 2019; 46:346-352. [DOI: 10.1016/j.anl.2018.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 10/09/2018] [Indexed: 10/27/2022]
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Ryan PJ, Patel NP. Endoscopic Management of Pediatric Cholesteatoma. J Otol 2018; 15:17-26. [PMID: 32110236 PMCID: PMC7033597 DOI: 10.1016/j.joto.2018.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 12/15/2022] Open
Abstract
Pediatric cholesteatoma occurs in one of two forms: congenital cholesteatoma, developing from embryonic epidermal cell rests or acquired cholesteatoma, associated with a focal defect in the tympanic membrane. This disease has been traditionally managed with the operating microscope, often requiring mastoidectomy for adequate visualization of and access to the middle ear and mastoid cavities. Recently, advances in endoscopic equipment have enabled otologists to manage most cases of pediatric cholesteatoma via a minimally-invasive, transcanal endoscopic approach. This review discusses the current literature relating to the etiopathogenesis, assessment and endoscopic management of pediatric cholesteatoma. Early outcomes of endoscopic treatment, emerging trends and technologies are also reviewed.
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Affiliation(s)
- Peter J Ryan
- Department of Otolaryngology and Head and Neck Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Nirmal P Patel
- Department of Otolaryngology and Head and Neck Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.,Kolling Deafness Research Centre, Macquarie University and University of Sydney, NSW, Australia
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Zanetti D, Di Lella F, Negri M, Vincenti V. Surgical management of middle ear cholesteatoma in children with Turner syndrome: a multicenter experience. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:382-388. [PMID: 30333463 PMCID: PMC6502115 DOI: 10.23750/abm.v89i3.5409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 05/03/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM As in other syndromes characterized by craniofacial anomalies, middle ear cholesteatoma is known to have a high prevalence in Turner syndrome. The aim of this study was to review a multicenter experience with the surgical management of middle ear cholesteatoma in children with Turner syndrome. METHODS We retrospectively analyzed sixteen girls with Turner syndrome who underwent otologic surgery for middle ear cholesteatoma between January 2000 and December 2012. Surgery was performed in 3 tertiary care otologic centers. Four patients had bilateral disease, resulting in a total of 20 ears treated. The following data were recorded: age, history of ventilation tube insertion, status of the controlateral ear, cholesteatoma location and extension, and surgical technique involved. Cholesteatoma recidivism, stable mastoid cavity and hearing levels were the main outcomes measured. RESULTS Follow-up ranged from 3 to 15 years (mean 7 years). Fourteen ears underwent canal wall down mastoidectomy: no cases of recurrent cholesteatoma were observed in these cases; revision mastoidectomy with cavity obliteration was needed in 2 ears (14.3%) for recurrent otorrhea. In the remaining 6 ears a staged canal wall up mastoidectomy was performed: 1 child showed a recurrent cholesteatoma and required conversion to canal wall down mastoidectomy. A postoperative air-bone gap result of 0 to 20 dB was achieved in 6 ears (30%); in 9 ears (45%) postoperative air-bone gap was between 21 and 30 dB, while in 5 (25%) was >30 dB. Bone conduction thresholds remained unaffected in all cases. CONCLUSIONS Cholesteatoma in children with Turner syndrome is a challenging entity for the otologic surgeon. Although not mandatory, canal wall down mastoidectomy should be regarded as the technique of choice to achieve a safe and dry ear in TS children with middle ear cholesteatoma. Intact canal wall mastoidectomy should be adopted only in appropriately selected patients such as those with limited attic cholesteatoma that can be regularly followed-up.
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Affiliation(s)
- Diego Zanetti
- Department of Audiology, University of Milano, IRCSS Policlinico "Ca' Granda", Milano, Italy.
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Rohlfing ML, Sukys JM, Poe D, Grundfast KM. Bilateral congenital cholesteatoma: A case report and review of the literature. Int J Pediatr Otorhinolaryngol 2018; 107:25-30. [PMID: 29501306 DOI: 10.1016/j.ijporl.2018.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 01/07/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Congenital cholesteatoma (CC) occurs less commonly than acquired cholesteatoma (AC), and bilateral CC (BCC) is even more rare with only 38 such cases having been reported in the past 42 years. Because of the rarity of this condition, providers confronted with cases of BCC may find it difficult to treat while balancing complete removal of disease, optimal hearing outcomes, and minimized surgical burden in the pediatric patient. This review alerts physicians that BCC occurs, highlights past presentations and management strategies, describes the considerations in treatment and offers an algorithm helpful in the management of BCC. METHODS Review of a single case with extensive review of published reports from 1975 to 2017 pertaining to management of BCC. RESULTS A five-year-old boy presented with bilateral congenital cholesteatoma. Tympanomastoidectomy was performed to remove cholesteatoma in the left ear then in the right ear months later. Ossicular chain reconstruction was deferred in both cases. Second look procedures revealed persistent cholesteatoma in both ears. In the descriptions of the 38 published BCC cases, the extent and location of the CC varied widely as did the approach to management. In the 18 cases that had descriptions of surgical management, four had second look procedures. In the 16 reports that described extent of cholesteatoma, 12 had the first of two or more operations on the ear with more extensive cholesteatoma. CONCLUSIONS Risks are increased for recidivism/recurrence and hearing impairment in children with BCC compared to children with unilateral CC. We present a novel algorithm for management of BCC that recommends surgery for cholesteatoma removal first in the more severely affected ear and delayed OCR for both ears. Simultaneous surgery may be considered in certain cases.
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Affiliation(s)
- Matthew L Rohlfing
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston, MA, United States.
| | - Jordan M Sukys
- Boston University School of Medicine, Boston, MA, United States.
| | - Dennis Poe
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
| | - Kenneth M Grundfast
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston, MA, United States.
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