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Molinari G, Reale M, Albera A, Russo FY, Di Lullo AM, Gaffuri M, Ralli M, Turri-Zanoni M, Simon F, Anschuetz L, Trecca EMC. Follow-up strategies in pediatric cholesteatoma: a systematic review. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08875-8. [PMID: 39097857 DOI: 10.1007/s00405-024-08875-8] [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: 05/02/2024] [Accepted: 07/25/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE The aim of this article was to systematically review the literature on the pediatric population surgically treated for cholesteatoma and describe the applied post-operative follow-up strategies. METHODS A systematic review was conducted following the Primary Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement recommendations. After running the selected search string in PubMed, Scopus and Google Scholar, studies in English, reporting on surgically treated pediatric cholesteatoma patients (age younger or equal to 18 year-old) were retrieved. Both primary and revision cholesteatoma surgeries were included. Articles lacking specific data on post-surgical follow-up and case series with less than 10 patients were excluded. RESULTS Nineteen papers, published between 2000 and 2023, were included for final analysis. Fourteen studies were retrospective and five prospective, for a total of 1319 patients and 1349 operated ears. Male to female ratio was 1.8:1, with a mean age at surgery of 10.4 years (range 1-18). The mean length of the follow-up after surgery was 4.4 ± 1.7 years (range 1-6.9). Clinical follow-up was detailed in 9 studies (47%) with otomicroscopy being the most common evaluation. In most articles (n = 8, 50%), MRI alone was utilized for radiological follow-up, while in 3 studies (19%), CT scans were employed exclusively. In 5 studies (31%), MRI was combined with CT scans. The timing of radiological investigations varied widely (ranging from 6 months to 3 years). A second-look strategy was reported in 14 studies (74%). CONCLUSION This systematic review highlights the heterogeneity of the follow-up strategies applied to pediatric patients after cholesteatoma surgery, both in terms of timing and types of investigations.
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Affiliation(s)
- Giulia Molinari
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Marella Reale
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy.
- Department of Otorhinolaryngology, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Andrea Albera
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francesca Yoshie Russo
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Antonella Miriam Di Lullo
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Otorhinolaryngology - Head and Neck Surgery Unit, Department of Mental and Physical Health and Preventive, Medicine, University of Campania Luigi Vanvitelli, 80131, Naples, Italy
- CEINGE- Advanced Biotechnology, Salvatore G. Street N.486, 80131, Naples, Italy
| | - Michele Gaffuri
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Massimo Ralli
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Mario Turri-Zanoni
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, 21100, Varese, Italy
- Department of Otolaryngology Head and Neck Surgery, Department of Biotechnology and Life Sciences, ASST Lariana, Ospedale Sant'Anna, University of Insubria, San Fermo Della Battaglia, 22042, Como, Italy
| | - Francois Simon
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, 75015, Paris, France
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland
| | - Eleonora M C Trecca
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Otorhinolaryngology and Maxillofacial Surgery, IRCCS Research Hospital Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Foggia, Italy
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Kaya E, Kaya F, Kaya Mİ, Çaklı H, İncesulu ŞA. A study on the efficacy of combined surgery in advanced-stage congenital cholesteatoma with canal-wall-up surgery. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08820-9. [PMID: 39025976 DOI: 10.1007/s00405-024-08820-9] [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: 05/10/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE This study aimed to compare the outcomes of patients with advanced congenital cholesteatoma who underwent microscopic or endoscope-combined Canal Wall Up Tympanomastoidectomy (CWUT) in our clinic and to determine the contribution of endoscope use in reducing recurrence/residual rates. METHODS In this retrospective study, the data of individuals who underwent microscopic or combined endoscopic surgery between 2008 and 2022 in our clinic were scanned from the database. Demographic data, preoperative computed tomography (CT) findings, preoperative and postoperative hearing results, operation and intraoperative status of the ossicles, duration of surgery, postoperative follow-up period, recurrence and residual disease status during follow-up were investigated. RESULTS The data of 37 pediatric cases operated in our clinic were included in the study. All of the included cases were Potsic Stage 4 patients who underwent CWUT. The mean age of the operated individuals was 8.7 years (5-12 years) and the mean follow-up period was 47.3 months (12-112 months). 19 cases were performed microscopically only, 2 recurrences and 5 residuals were detected. 18 cases were performed combined and 1 recurrence and 1 residual was found. CONCLUSION In this study, it was determined that using an endoscope together with a microscope in congenital cholesteatoma cases, decreased the rate of recurrence and residual disease by protecting the external auditory canal in patients with advanced mastoid invasion.
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Affiliation(s)
- Ercan Kaya
- Department of Otorhinolaryngology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Furkan Kaya
- Department of Otorhinolaryngology, Yunus Emre State Hospital, Eskişehir, Türkiye.
| | - Melike İtgin Kaya
- Department of Otorhinolaryngology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Hamdi Çaklı
- Department of Otorhinolaryngology, Eskişehir Osmangazi University, Eskişehir, Turkey
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Solis-Pazmino P, Siepmann T, Scheffler P, Ali NES, Lincango-Naranjo E, Valdez TA, Prokop LJ, Min-Woo Illigens B, Ponce OJ, Ahmad IN. Canal wall up versus canal wall down mastoidectomy techniques in the pediatric population with cholesteatoma: A systematic review and meta-analysis of comparative studies. Int J Pediatr Otorhinolaryngol 2023; 173:111658. [PMID: 37666040 DOI: 10.1016/j.ijporl.2023.111658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 09/06/2023]
Abstract
IMPORTANCE The optimal surgical management of cholesteatoma remains controversial. Within pediatric otolaryngology, one of the most vital points of contention is the selection of canal wall-up (CWU) versus canal wall-down (CWD) procedures. Pediatric cholesteatoma has high rates of recurrence (16%-54%). In adults, there is evidence that the selection of surgical techniques affects recurrence rates. This has not been shown in children. OBJECTIVES 1. To systematically review the literature on recurrent and residual cholesteatoma after CWU and CWD in children and perform a meta-analysis of the data. 2. To assess the rates of recurrent and residual cholesteatoma between CWU and CWD techniques in pediatric patients. 3. To assess hearing outcomes by evaluating postoperative differences in the air-bone gap (ABG) between CWU and CWD techniques. DATA SOURCES A systematic search of PubMed, Embase, Scopus, and Cochrane Collaboration was performed from inception to May 1st, 2020, to identify studies that compared CWU and CWD procedures for acquired cholesteatoma in children. STUDY SELECTION Search records were screened in duplicate by four reviewers. Inclusion criteria consisted of comparative randomized clinical trials and observational studies assessing outcomes of CWU and CWD techniques in the pediatric population. Studies involving patients with congenital cholesteatoma were excluded. DATA EXTRACTION AND SYNTHESIS Four reviewers working independently and in duplicate systematically reviewed and extracted study data. Dichotomous variables were analyzed as risk ratios (RR), while continuous variables were compared using weighted mean differences (MD). The risk of bias was assessed using the CLARITY Scale. PRIMARY OUTCOMES AND MEASURES The outcomes were recurrence, residual disease, air-bone gap (ABG), and air conductive (AC) thresholds. RESULTS After screening 1036 publications, 17 retrospective cohort studies were selected. 1333 children were included; the overall mean age was ten years (SD 7.9), and the overall mean follow-up time was 5.9 years (SD 6.6). CWU and CWD techniques were performed in 60% (796) and 40% (537) cases. We did not find differences in cholesteatoma recurrence (RR: 1.50, 95% CI 0.94; 2.40; n = 544; I2 0%; Tau [2]: 0.00), or rates of residual cholesteatoma (RR 1.51, 95% CI 0.96; 2.38, n = 506; I2: 0%; Tau [2]: 0.00) in patients who underwent CWU and CWD mastoidectomy. The mean air-bone gap was lower with CWU than CWD (mean difference: 7.60, 95% CI -10.65; -4.54; n = 242; I2: 71%; Tau [2]: 5.98). CONCLUSION and relevance: We show similar rates of recurrence and residual disease after either CWU or CWD tympanoplasty. Our results challenge the fundamental principle of CWD surgery as a standard technique, as there is no difference in rates of recurrence and residual disease in CWU and CWD. Moreover, audiometric results support CWU with improved hearing outcomes. TRIAL REGISTRATION PROSPERO identifier: CRD42020184029.
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Affiliation(s)
- Paola Solis-Pazmino
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA; Division of Health Care, Dresden International University, Dresden, Germany
| | - Timo Siepmann
- Division of Health Care, Dresden International University, Dresden, Germany; Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Patrick Scheffler
- Department of Otolaryngology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Noor-E-Seher Ali
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Southern Illinois University, Springfield, IL, USA
| | - Eddy Lincango-Naranjo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA; Division of Health Care, Dresden International University, Dresden, Germany
| | - Tulio A Valdez
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Larry J Prokop
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Oscar J Ponce
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | - Iram N Ahmad
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA.
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Hu X, Chen M, Dai W, Zhang C, Li S. Efficiency of intraoperative endoscopic inspection in reducing residuals in canal-wall-up surgery for pediatric cholesteatoma involving the mastoid. Eur Arch Otorhinolaryngol 2023:10.1007/s00405-023-07857-6. [PMID: 36700981 DOI: 10.1007/s00405-023-07857-6] [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: 11/14/2022] [Accepted: 01/20/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To investigate the efficiency of additional intraoperative endoscopic inspection in reducing residual cholesteatoma in pediatric cholesteatoma involving the mastoid treated with classic canal-wall-up mastoidectomy and tympanoplasty. MATERIALS AND METHODS 32 cases of pediatric cholesteatoma involving the mastoid were enrolled in this perspective study and treated with classic canal-wall-up mastoidectomy and tympanoplasty. Transmastoid posterior tympanotomy, atticotomy and transecting tendon of tympani tensor were conducted to achieve adequate visualization of hidden spaces in the middle ear. After complete removal of cholesteatoma, endoscopic inspection was additionally performed to check residual cholesteatoma. All cases had at least a 2-year follow-up by routine otoscopy examination, CT scan or MR imaging. Residual rates of both intraoperative and follow-up findings were used to evaluate the efficiency of the endoscopic inspection in reducing residual cholesteatoma and compared with published reports. RESULTS The additional intraoperative endoscopic inspection did not find any residual in this case series. In the 2-year follow-up, 2 cases (2/32, 6.3%) with residual cholesteatoma and 3 cases with recurrence (3/32, 9.4%) were found. The mean duration of endoscopic inspection and microscopic procedure were 17.9 min and 93.6 min, respectively. CONCLUSIONS This study suggested that the additional intraoperative endoscopic inspection in microscopic CWU surgery for pediatric cholesteatoma involving the mastoid had no obvious value in reducing residual cholesteatoma but took extra time.
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Affiliation(s)
- Xuerui Hu
- Department of Otolaryngology and Head-Neck Surgery, ENT Institute, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Min Chen
- Department of Otolaryngology and Head-Neck Surgery, ENT Institute, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Wenjia Dai
- Department of Otolaryngology and Head-Neck Surgery, ENT Institute, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Chen Zhang
- Department of Otolaryngology and Head-Neck Surgery, ENT Institute, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Shufeng Li
- Department of Otolaryngology and Head-Neck Surgery, ENT Institute, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China.
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Comparative Analysis of Recidivism After Endoscopic and Microscopic-Based Cholesteatoma Resection. Otol Neurotol 2022; 43:466-471. [DOI: 10.1097/mao.0000000000003476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Qian ZJ, Tran ED, Alyono JC, Cheng AG, Ahmad IN, Chang KW. Trends and Healthcare Use Following Different Cholesteatoma Surgery Types in a National Cohort, 2003-2019. Otol Neurotol 2021; 42:e1293-e1300. [PMID: 34310551 PMCID: PMC8448909 DOI: 10.1097/mao.0000000000003284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe national trends in cholesteatoma management. STUDY DESIGN AND SETTING Retrospective analysis Optum Clinformatics® Database from 2003 to 2019. PATIENTS 16,179 unique adult and pediatric patients who received cholesteatoma surgery. INTERVENTIONS AND MAIN OUTCOME MEASURES Patients were categorized into three groups by initial surgical modality: canal wall down (CWD), canal wall up (CWU), and tympanoplasty without mastoidectomy (TnoM). Three major comparisons between groups were performed: 1) temporal trends, 2) clinical and sociodemographic determinants, and 3) healthcare use in terms of total costs and incidence of postoperative imaging and subsequent surgery. RESULTS Overall, 23.2% received initial CWD surgery, 44.3% CWU, and 32.5% TnoM. 1) The incidence of initial CWD surgery decreased (odds ratios [OR] = 0.98, 95% confidence intervals [CI] [0.97,0.99]), while CWU increased (OR = 1.02, 95% CI [1.01,1.03]), and TnoM remained stable over the study period (OR = 0.99, 95% CI [0.98,1.00]). 2) Relative to CWU, TnoM surgery was less likely in adults, patients with prior complications, and non-White patients, while being more likely in patients with higher household income. CWD was more likely than CWU in adults, patients with prior complications, and non-White patients, while income had no effect. 3) Postoperative costs for CWU and CWD were similar. In 2 years following initial surgery, postoperative imaging and/or subsequent surgery was performed in 45.48% of CWD, 57.42% of CWU, and 41.62% of TnoM patients. CONCLUSIONS Incidence of initial CWD surgery decreased and social disparities in cholesteatoma management were observed. Postoperative imaging or second-look surgery were performed in less than 60% of patients with initial CWU surgery and over 40% of patients with initial CWD.
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Affiliation(s)
- Zhen Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Moroco AE, Saadi RA, Baker AR, Zhu J, Isildak H. Usage Patterns of CT and MRI in the Evaluation of Otologic Disease. Otol Neurotol 2021; 42:e698-e708. [PMID: 33606467 DOI: 10.1097/mao.0000000000003095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the current trends and usage patterns of radiographic imaging for otologic disease by specialty, length of practice, practice setting, geographic region, and pediatric volume. STUDY DESIGN Cross-sectional study. SETTING Survey of physicians. SUBJECTS General Otolaryngologists and Otologists/Neurotologists (O/N) of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS). METHODS AND OUTCOME MEASURES An electronic questionnaire was distributed to AAO-HNS members. Respondents were separated into groups by specialty, length of practice, practice setting, region, and pediatric exposure. Chi-square tests were performed for the determination of significance. RESULTS The survey was sent to 5,168 members of AAO-HNS. The response rate was 10.6% (n = 546) and 18.1% for only O/N (n = 143). Most respondents were generalists (74%), in practice >20 years (51%), with a primarily adult practice (95%). O/N were more often academics (44 versus 17% combined, 40% private; p < 0.001) and saw fewer children (80 fewer than 25%; p < 0.001). Compared with generalists, O/N were more likely to respond with more frequent and earlier magnetic resonance imaging (MRI) utilization in the workup of the majority of otologic diseases. Significant differences in usage patterns for various conditions were demonstrated across all categories, but specialty training was the most common. Generalists (34 versus 12% of O/N; p < 0.001), physicians practicing >20 years (32 versus 18% of < 5 yrs; p = 0.006), and private practice physicians (34 versus 14-20% of others; p < 0.001) relied more heavily on the radiology report to interpret MRI scans. CONCLUSION Subspecialty training seems to be the main variable correlating with significant differences in the use of MRI and computed tomography imaging in patients with otologic disease.
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Affiliation(s)
| | | | - Aaron R Baker
- Department of Otolaryngology - Head and Neck Surgery
| | - Junjia Zhu
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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Wei F, Sun Q, Qin Z, Zhuang H, Jiang G, Wu X. Application and practice of a step-by-step method combined with case-based learning in Chinese otoendoscopy education. BMC MEDICAL EDUCATION 2021; 21:89. [PMID: 33541330 PMCID: PMC7863487 DOI: 10.1186/s12909-021-02513-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 01/26/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Standardized training allows more physicians to master otoendoscopic surgery. However, the lecture-based learning (LBL) applied in otoendoscopy teaching may not be conducive to training students in clinical thinking and surgical ability. It is necessary to explore innovative methods for otoendoscopy teaching. This study aimed to determine the effect of a step-by-step (SBS) method combined with case-based learning (CBL) in otoendoscopy teaching. METHODS Fifty-nine physicians who participated in otoendoscopy training were selected as the study subjects and randomly divided into two groups (A and B). Group A underwent training with the SBS & CBL method, while Group B underwent training with the LBL & CBL method. The effects of these two methods for otoendoscopy training were compared by evaluation of professional skills and questionnaires before and after the training. RESULTS Proficiency in otoendoscopic anatomy and grades for both professional knowledge and otoendoscopic skills were significantly higher in Group A than in Group B(P < 0.05). In terms of learning interest, surgical ability, acting capacity during surgery, reducing surgical complications, and satisfaction with learning experience, all responses from Group A were better than those from Group B(P < 0.05). CONCLUSIONS The SBS & CBL method may help to improve ability in otoendoscopic surgery and clinical thinking and appears suitable for endoscopy teaching.
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Affiliation(s)
- Fanqin Wei
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, 2nd Zhongshan Road 58#, Guangdong, 510080, Guangzhou, People's Republic of China
- Institute of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangdong, 510080, Guangzhou, People's Republic of China
- Guangzhou Key Laboratory of Otorhinolaryngology, Guangdong, 510080, Guangzhou, People's Republic of China
| | - Qiyang Sun
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, 2nd Zhongshan Road 58#, Guangdong, 510080, Guangzhou, People's Republic of China
- Institute of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangdong, 510080, Guangzhou, People's Republic of China
- Guangzhou Key Laboratory of Otorhinolaryngology, Guangdong, 510080, Guangzhou, People's Republic of China
| | - Zili Qin
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, 2nd Zhongshan Road 58#, Guangdong, 510080, Guangzhou, People's Republic of China
- Institute of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangdong, 510080, Guangzhou, People's Republic of China
- Guangzhou Key Laboratory of Otorhinolaryngology, Guangdong, 510080, Guangzhou, People's Republic of China
| | - Huiwen Zhuang
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, 2nd Zhongshan Road 58#, Guangdong, 510080, Guangzhou, People's Republic of China
- Institute of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangdong, 510080, Guangzhou, People's Republic of China
- Guangzhou Key Laboratory of Otorhinolaryngology, Guangdong, 510080, Guangzhou, People's Republic of China
| | - Guangli Jiang
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, 2nd Zhongshan Road 58#, Guangdong, 510080, Guangzhou, People's Republic of China
- Institute of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangdong, 510080, Guangzhou, People's Republic of China
- Guangzhou Key Laboratory of Otorhinolaryngology, Guangdong, 510080, Guangzhou, People's Republic of China
| | - Xuan Wu
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, 2nd Zhongshan Road 58#, Guangdong, 510080, Guangzhou, People's Republic of China.
- Institute of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangdong, 510080, Guangzhou, People's Republic of China.
- Guangzhou Key Laboratory of Otorhinolaryngology, Guangdong, 510080, Guangzhou, People's Republic of China.
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Hervochon R, Elmaleh-Berges M, Francois M, Marhic A, Bahakim A, Teissier N, Abbeele TVD. Positive predictive value for diffusion-weighted magnetic resonance imaging in pediatric cholesteatoma: A retrospective study. Int J Pediatr Otorhinolaryngol 2020; 139:110416. [PMID: 33027732 DOI: 10.1016/j.ijporl.2020.110416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/26/2020] [Accepted: 09/26/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aims of this study were first to calculate the Positive Predictive Value (PPV) of DW-MRI to detect cholesteatoma and then to analyze false positives. METHODS All temporal bone MRI with DWI sequences performed in our pediatric university hospital between 2005 and 2015 were included retrospectively. 46 patients with a cholesteatoma diagnosis on the MRI report and who underwent surgery were studied. RESULTS The number of DW-MRI for identification of cholesteatoma has grown in ten years. We calculated an 89% Positive Predictive Value. DW-MRI sensitivities were 100.0% and 70.7% for respectively keratin and squamous epithelium. CONCLUSION DW-MRI hypersignal is not synonymous of cholesteatoma diagnosis. Indeed, this diagnosis relies on the importance of a proper otoscopic examination, a suggestive medical history, CT scan data and analysis of other MRI sequences, including T1-weighted sequence, to rule out other etiologies of middle ear DW-MRI hypersignal.
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Affiliation(s)
- Rémi Hervochon
- ENT Department, Robert Debré Hospital, Paris, France; ENT Department, Pitié - Salpêtrière Hospital, Paris, France.
| | | | | | - Alix Marhic
- ENT Department, Robert Debré Hospital, Paris, France
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Abstract
Since its introduction into the field of otology in 1967 endoscopes are gaining acceptance in evaluation and treatment of middle ear disease. Endoscopes offer a wide field view enabling looking "around the corner" with reduced need for soft tissue and bone removal. Outcomes of middle ear surgery for cholesteatoma and need for second-look procedures are improving because of the addition of endoscopic evaluation. Trainee education using the endoscope improves knowledge of middle ear anatomy. The portability of the endoscopic unit allows performing ear surgery in remote locations.
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Affiliation(s)
- Michal Preis
- Department of Otolaryngology, Maimonides Medical Center, State University of NY Downstate, 919 49th Street, Brooklyn, NY 11219, USA.
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Anikin IA, Bokuchava TA, Khamgushkeeva NN, Knyazev AD. [Predictors of recurrent pathology and prognosis of the results of surgical treatment of patients with acquired middle-ear cholesteatoma]. Vestn Otorinolaringol 2020; 85:6-10. [PMID: 32885629 DOI: 10.17116/otorino2020850416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A retrospective analysis of the results of surgical treatment of 436 patients (332 adults and 104 children under the age of 15 years) with acquired middle ear cholesteatoma was performed to identify possible predictors of relapse of the process and a prospective assessment of the results of surgical treatment. It was revealed that the leading factors in the development of residual pathology were: the presence of cholesteatoma in the area of destruction of the bone wall of the canal of the facial nerve, cholesteatoma of the hypothympanum, cholesteatoma in the place of destruction of the bone wall of the posterior cranial fossa. The key reasons for the formation of recurrent pathology were: children under 15 years of age, closed surgery, pathological changes in the tympanic orifice of the auditory tube and the presence of cholesteatoma in its lumen. Performing a closed operation in adults with pathology of the tympanic orifice of the auditory tube increases the risk of recurrent cholesteatoma by 18.6%, and in children by 20%. The choice of a closed method of surgical intervention for the epitympanic type of the disease can increase the risk of residual pathology by 17.2% in adults and 27.8% in children.
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Affiliation(s)
- I A Anikin
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
| | - T A Bokuchava
- Bayandin Murmansk Regional Clinical Hospital, Murmansk, Russia
| | - N N Khamgushkeeva
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
| | - A D Knyazev
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
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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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