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Kwok HM, Cheung CHL, Ng TF, Lam SY, Wong KHS, Wong HL, Pan NY, Cheng LF, Ma KFJ. Congenital cholesteatoma: what radiologists need to know. Pediatr Radiol 2024; 54:620-634. [PMID: 38393651 DOI: 10.1007/s00247-024-05877-w] [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: 10/24/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Congenital cholesteatoma is a rare, non-neoplastic lesion that causes conductive hearing loss in children. It is underrecognized and often diagnosed only when there is an established hearing deficit. In the pediatric population, hearing deficiency is particularly detrimental because it can impede speech and language development and, in turn, the social and academic well-being of affected children. Delayed diagnosis leads to advanced disease that requires more extensive surgery and a greater chance of recurrence. A need to promote awareness and recognition of this condition has been advocated by clinicians and surgeons, but no comprehensive imaging review dedicated to this entity has been performed. This review aims to discuss the diagnostic utility of high-resolution computed tomography and magnetic resonance imaging in preoperative and postoperative settings in congenital cholesteatoma. Detailed emphasis is placed on the essential preoperative computed tomography findings that facilitate individualized surgical management and prognosis in the pediatric population.
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Affiliation(s)
- Hoi Ming Kwok
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong.
| | - Chun Hei Lewey Cheung
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Ting Fung Ng
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Sun Yu Lam
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Ka Hon Stephen Wong
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Ho Lim Wong
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Nin Yuan Pan
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Lik Fai Cheng
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Ka Fai Johnny Ma
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
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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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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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Miura M, Yamamoto Y, Takahashi M, Komori M, Yamamoto K, Kojima H. Congenital cholesteatoma assessment based on staging and classification criteria for middle ear cholesteatoma proposed by the Japan Otological Society. Auris Nasus Larynx 2020; 48:201-206. [PMID: 32800394 DOI: 10.1016/j.anl.2020.07.022] [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] [Received: 06/04/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to assess the clinical characteristics of extent patterns in congenital cholesteatoma, based on the Japan Otological Society (JOS) staging system. METHODS This was a retrospective chart review that included 80 ears of 80 patients with congenital cholesteatoma who underwent primary surgery at a tertiary academic medical center. The main characteristics and outcomes reviewed were sex, age, clinical background, surgical method, and stage classification according to two staging classifications: the criteria advocated by JOS and Potsic staging system. RESULTS The age at the time of surgery ranged from 1 to 35 years (average 8.4 years), and there were 54 men and 26 women. According to the JOS staging system, 12 ears were Stage Ia (15%), 7 ears were Stage Ib (9%), 1 ear was Stage Ic (1%), 59 ears were Stage II (74%), and 1 ear was Stage III (1%). In the study of postoperative residual recurrence, there were 4 cases after the primary operation and 3 cases after the staged operation. All 3 ears with residual disease after planned surgery were cholesteatomas that extended to all the tympanomastoid space. CONCLUSION We consider the JOS staging system to be more suitable, in terms of anatomical classification and surgical procedure selection for comparison between Europe, the United States, and Asia. Specifically, it was advantageous that the PTAM classification and the S classification are associated with surgical procedure selection and postoperative course.
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Affiliation(s)
- Masahiro Miura
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan; Department of Otorhinolaryngology, Ota General Hospital, Kanagawa, Japan.
| | - Yutaka Yamamoto
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Takahashi
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Manabu Komori
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhisa Yamamoto
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
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Hao J, Chen M, Liu B, Yang Y, Liu W, Zhang J, Ni X. The Significance of Staging in the Treatment of Congenital Cholesteatoma in Children. EAR, NOSE & THROAT JOURNAL 2020; 100:1125S-1131S. [PMID: 32603216 DOI: 10.1177/0145561320933965] [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] Open
Abstract
OBJECTIVES To analyze the clinical characteristics of congenital cholesteatoma (CC), to explore the risk factors related to recurrence of the disease, and to clarify the importance of staging for treatment. METHODS A total of 87 patients were followed up for more than 5 years, who had undergone surgical procedures for CC from September 2010 to January 2017 in Beijing Children's Hospital, Capital Medical University. Patients with CC were identified in accordance with the following Levenson's criteria. The clinical characteristics of CC on different stage and risk factors related to recurrence of the disease were analyzed. RESULTS Canal wall up mastoidectomy and tympanoplasty (n = 45), transcanal endoscopic approach (n = 29), and canal wall down mastoidectomy and tympanoplasty (n = 13) was, respectively, performed depending on cholesteatoma extension. Between 2010 and 2013, 20.93% of patients had stage I-II disease, whereas 61.26% had stage I-II disease from 2014 to 2017. Meanwhile, the proportion with stage III-IV disease decreased from 79.07% to 38.64% between these 2 time periods. The preoperative air conduction threshold in patients with stage I, II, III, and IV was, respectively, 23.36 ± 8.20, 45.40 ± 12.82, 47.49 ± 12.03, and 50.37 ± 11.80 dB. The stage of disease was a significant risk factor regarding recurrence (P = .02). Surgery on patients with stage III-IV disease was performed with the aid of a microscope from 2010 to 2013 and with a microscope and endoscope from 2014 to 2017, which reduced the recurrence rate from 26.92% in the former period to 8.33% in the latter period. CONCLUSION Early detection of CC is crucial regarding the facilitation of minimally invasive surgery and reducing complication and recurrence rates. The stage of the disease is a significant risk factor regarding recurrence. The surgery shows us the possibility of reducing the recurrence rate of CC, which is performed under a microscope and an endoscope.
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Affiliation(s)
- Jinsheng Hao
- National Center for Children's Health, Beijing, People's Republic of China.,Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Min Chen
- National Center for Children's Health, Beijing, People's Republic of China.,Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Bing Liu
- National Center for Children's Health, Beijing, People's Republic of China.,Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yang Yang
- National Center for Children's Health, Beijing, People's Republic of China.,Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wei Liu
- National Center for Children's Health, Beijing, People's Republic of China.,Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jie Zhang
- National Center for Children's Health, Beijing, People's Republic of China.,Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xin Ni
- National Center for Children's Health, Beijing, People's Republic of China.,Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
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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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Park JH, Ahn J, Moon IJ. Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma. Clin Exp Otorhinolaryngol 2018; 11:233-241. [PMID: 29940721 PMCID: PMC6222188 DOI: 10.21053/ceo.2018.00122] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/20/2018] [Indexed: 11/22/2022] Open
Abstract
Objectives As endoscopic instrumentation, techniques and knowledges have significantly improved recently, endoscopic ear surgery has become increasingly popular. Transcanal endoscopic ear surgery (TEES) can provide better visualization of hidden areas in the middle ear cavity during congenital cholesteatoma removal. We aimed to describe outcomes for TEES for congenital cholesteatoma in a pediatric population. Methods Twenty-five children (age, 17 months to 9 years) with congenital cholesteatoma confined to the middle ear underwent TEES by an experienced surgeon; 13 children had been classified as Potsic stage I, seven as stage II, and five as stage III. The mean follow-up period was 24 months. Recurrence of congenital cholesteatoma and surgical complication was observed. Results Congenital cholesteatoma can be removed successfully via transcanal endoscopic approach in all patients, and no surgical complications occurred; only one patient with a stage II cholesteatoma showed recurrence during the follow-up visit, and the patient underwent revision surgery. The other patients underwent one-stage operations and showed no cholesteatoma recurrence at their last visits. Two patients underwent second-stage ossicular reconstruction. Conclusion Although the follow-up period and number of patients were limited, pediatric congenital cholesteatoma limited to the middle ear cavity could be safely and effectively removed using TEES.
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Affiliation(s)
- Joo Hyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jungmin Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Il Joon Moon
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hatano M, Ito M, Sugimoto H, Noda M, Hasegawa H, Yoshizaki T. Soft-wall reconstruction of the canal wall with retrograde bone work for pediatric cholesteatoma: Long-term results. Int J Pediatr Otorhinolaryngol 2016; 91:159-165. [PMID: 27863632 DOI: 10.1016/j.ijporl.2016.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/22/2016] [Accepted: 10/24/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To retrospectively evaluate the long-term results of surgery for retrograde bone work, using soft-wall reconstruction of the canal wall, for pediatric cholesteatoma. METHODS We retrospectively evaluated a series of 25 consecutive ears of 24 patients who were ≤16 years of age. All children underwent cholesteatoma surgery between October 2002 and August 2008. The type of cholesteatoma, the length of follow-up, the incidence of residual and recurrent cholesteatoma, postoperative hearing results, and the form of the reconstructed external canal wall and tympanic membrane were assessed. RESULTS There were 21 males and 3 females. The procedure was performed on both ears of one patient who had bilateral congenital cholesteatoma (CC). At the initial surgery, 16 cases (64%) had CC and nine (36%) had acquired cholesteatoma (AC). The mean age at surgery was 8.2 years and 10.4 years for CC and AC cases, respectively. The mean postoperative follow-up period after the initial surgery was 90 months for CC cases and 108 months for AC cases. Cholesteatoma recurrence occurred for 6% and 56% of cases with CC and AC, respectively. Successful serviceable hearing was achieved for 93.8% with CC and 100% with AC. Cases with inadequate hearing after surgery were characterized by disease extension to the mastoid and the protympanum. The long-term forms of the reconstructed external canal wall changed depending on their middle ear aeration. Some cases of tympanic membrane perforation and otitis media with effusion were occurred during the follow-up period. CONCLUSION Overall, the retrograde approach with soft-wall reconstruction of the canal wall achieved a low recurrence rate for cholesteatoma and good hearing outcomes during long-term follow-up for the pediatric case. However, in cases with eustachian tube dysfunction and/or cholesteatoma involving the protympanum, the hearing outcomes were less favorable.
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Affiliation(s)
- Miyako Hatano
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan.
| | - Makoto Ito
- Department of Pediatric Otolaryngology, Jichi Medical University, Tochigi Pediatric Medical Center, Tochigi, Japan
| | - Hisashi Sugimoto
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Masao Noda
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroki Hasegawa
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tomokazu Yoshizaki
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
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Jang CH, Jung EK, Sung CM, Kim SB, Kim YY, Seong JY, Kang SH, Cho YB. Minimally invasive transcanal myringotomy for pediatric early stage congenital cholesteatoma. Int J Pediatr Otorhinolaryngol 2016; 90:1-4. [PMID: 27729113 DOI: 10.1016/j.ijporl.2016.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Recently, minimally invasive transcanal myringotomy (MITM), which is a useful surgical technique for early stage congenital cholesteatoma (CC) in children, was introduced. The purpose of this study is to evaluate the short-term surgical results of MITM in pediatric early stage CC. MATERIALS AND METHODS We retrospectively reviewed the charts of 24 patients who underwent MITM between January 2013 and October 2015. RESULTS The patients' ages ranged from 1 to 16 years (mean, 2.6 years). There were 17 male and 7 female patients. The right side (n = 13) was affected twice as often as the left side (n = 11). The most common site was the anterosuperior quadrant (15 cases). The diameter of the CC on axial computed tomography images ranged from 2.8 to 5.7 mm (mean, 3.9 mm). CCs were graded according to Potsic's system: 18 cases were classified as stage I, 3 case as stage II, and 3 cases as stage III. AllCCs except 1 were closed type. In21 patients, the tympanic membrane closed naturally without recurrence. Three patients showed small persistent dry perforation. Natural closure occurred in these patients, who were treated with paper patches. CONCLUSION MITM is a simple, effective technique for removing an early stage CC from the middle ear, and it can minimize operative time, length of hospitalization, and postoperative morbidity.
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Affiliation(s)
- Chul Ho Jang
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea.
| | - Eun Kyung Jung
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Chung Man Sung
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Seung Beom Kim
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Young Yoon Kim
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Jong Yuap Seong
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung Hoon Kang
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Yong Beom Cho
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
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Efficacy and Safety of Transcanal Endoscopic Ear Surgery for Congenital Cholesteatomas. Otol Neurotol 2015; 36:1644-50. [DOI: 10.1097/mao.0000000000000857] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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The difference in congenital cholesteatoma CT findings based on the type of mass. Diagn Interv Imaging 2015; 97:65-9. [PMID: 25846685 DOI: 10.1016/j.diii.2015.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 02/19/2015] [Accepted: 02/19/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A retrospective assessment of differences in congenital cholesteatoma CT findings with a focus on type of cholesteatoma mass. MATERIALS AND METHODS The medical records and CT images of 14 patients with congenital cholesteatomas in the middle ear who underwent surgery at our institution between January 2009 and July 2014 were reviewed. Cholesteatomas were classified as closed type, open type, or mixed type based on intraoperative findings. The CT findings including cholesteatoma size, location, and shape were retrospectively reviewed. RESULTS Eight patients had closed type cholesteatomas, four had mixed type, and two had open type. The mean size of all cholesteatomas was 5.1mm. None of the cholesteatoma types indicated a tendency towards a certain location. The round shape was observed more frequently in closed type cholesteatomas than in other types (closed: 5/8; mixed: 1/4; open: 0/2). Two large closed type cholseteatomas and two mixed type cholesteatomas exhibited a constricted shape. Both of the open type cholesteatomas displayed an irregular shape. CONCLUSION Small closed type congenital cholesteatomas were typically observed as round shaped lesions, but large closed type cholesteatomas and other type cholesteatomas tended to display shapes other than round.
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Open vs closed type congenital cholesteatoma of the middle ear: two distinct entities or two aspects of the same phenomenon? Int J Pediatr Otorhinolaryngol 2014; 78:2205-9. [PMID: 25458161 DOI: 10.1016/j.ijporl.2014.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 10/04/2014] [Accepted: 10/10/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The clinical features and surgical results of "closed type" versus "open type" congenital cholesteatoma were compared in order to analyse the differences between the two forms; whether the morphology of the disease may have a role in the staging systems has been also evaluated. PATIENTS AND METHODS We reviewed retrospectively 95 patients (96 ears) who underwent surgery for congenital cholesteatoma over a 15-year period focusing on the clinical differences between open and closed type congenital cholesteatoma. RESULTS Seventy-one patients (74%) had a closed-type and 25 (26%) an open type congenital cholesteatoma. Our study confirmed the higher prevalence of the closed type, as well as, a younger age at initial diagnosis compared with the open type congenital cholesteatoma. Other differences between the two forms were: modality of diagnosis (pathognomonic otoscopy in 100% of the closed type and in 40% of the open type), positive history for otitis media with effusion (51.4% in closed type vs 20% in open type), involvement of the tympanic membrane quadrants (anterior quadrants were more frequently involved in the closed forms, whereas posterior quadrants were more frequently involved in the open forms), disease extension and aggressiveness. A residual cholesteatoma was found in 6 out of the 71 patients (8.4%) with a closed type congenital cholesteatoma and in 10 out of the 25 patients (40%) with an open type congenital cholesteatoma. After adjusting for potential confounders, open-type congenital cholesteatoma was significantly associated with residual cholesteatoma compared to the closed-type (odds ratio [OR] 7.39, 95% confidence interval [CI] 1.10-49.77, p=0.03). CONCLUSION This study confirmed that the open congenital cholesteatoma has global clinical features that are uniquely different from the classical closed form. These differences could reflect a distinct pathogenesis, but there is no proof of this to date. The classification of the congenital cholesteatoma could be further refined by adding the morphologic type of the disease.
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Takagi T, Gyo K, Hakuba N, Hyodo J, Hato N. Clinical features, presenting symptoms, and surgical results of congenital cholesteatoma based on Potsic's staging system. Acta Otolaryngol 2014; 134:462-7. [PMID: 24702226 DOI: 10.3109/00016489.2013.875218] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Potsic's staging system is a clinically useful procedure for evaluating the extent of congenital cholesteatoma (CC). OBJECTIVES We investigated the clinical features, presenting symptoms, and surgical results of CC according to Potsic's staging system. METHODS A total of 71 patients who had undergone surgery at our hospital were retrospectively analyzed for presenting symptoms, the location of cholesteatoma, and surgical results according to Potsic's staging system. RESULTS Of the 71 patients, 21 were classified as Potsic stage I, 9 as stage II, 31 as stage III, and 10 as stage IV. More than half of the patients with early-stage CC (stages I and II) were diagnosed asymptomatically by a chance visit to a clinic or on ear screening. Others were diagnosed following a complaint of hearing loss, acute otitis media, or otitis media with effusion. The location of CC varied somewhat by stage. In stage I CC, the most frequent location was behind the anterior-superior quadrant of the tympanic membrane; however, in stage III CC, it was behind the posterior-superior quadrant. All patients were treated surgically. Recurrence was detected in 2 of the 71 patients (2.8%); both had stage II CC. Recurrent lesions were removed during revision surgery.
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Affiliation(s)
- Taro Takagi
- Department of Otolaryngology, Ehime University, School of Medicine , Ehime , Japan
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