1
|
Körmendy KB, Shenker-Horváth K, Shulze Wenning A, Fehérvári P, Harnos A, Hegyi P, Molnár Z, Illés K, Horváth T. Predicting residual cholesteatoma with the Potsic staging system still lacks evidence: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:3557-3568. [PMID: 38351408 PMCID: PMC11211107 DOI: 10.1007/s00405-024-08478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/12/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE To investigate the rate of residual disease in the Potsic staging system for congenital cholesteatomas. METHODS A protocol registration was published on PROSPERO (CRD42022383932), describing residual disease as a primary outcome and hearing improvement as secondary. A systematic search was performed in four databases (PubMed, Embase, Cochrane Library, Web of Science) on December 14, 2022. Articles were included if cholesteatomas were staged according to the Potsic system and follow-up duration was documented. Risk of bias was evaluated using the Quality In Prognosis Studies (QUIPS) tool. In the statistical synthesis a random effects model was used. Between-study heterogeneity was assessed using I2. RESULTS Thirteen articles were found to be eligible for systematic review and seven were included in the meta-analysis section. All records were retrospective cohort studies with high risk of bias. Regarding the proportions of residual disease, analysis using the χ2 test showed no statistically significant difference between Potsic stages after a follow-up of minimum one year (stage I 0.06 (confidence interval (CI) 0.01-0.33); stage II 0.20 (CI 0.09-0.38); stage III 0.06 (CI 0.00-0.61); stage IV: 0.17 (CI 0.01-0.81)). Postoperative and preoperative hearing outcomes could not be analyzed due to varied reporting. Results on cholesteatoma location and mean age at staging were consistent with those previously published. CONCLUSION No statistically significant difference was found in the proportions of residual disease between Potsic stages, thus the staging system's applicability for outcome prediction could not be proven based on the available data. Targeted studies are needed for a higher level of evidence.
Collapse
Affiliation(s)
- Klára Borbála Körmendy
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinkszky Hospital, Budapest, Hungary
| | - Kinga Shenker-Horváth
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Morphology and Physiology, Semmelweis University, Budapest, Hungary
- Center for Sports Nutrition Science, Hungarian University of Sports Science, Budapest, Hungary
| | | | - Péter Fehérvári
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- University of Veterinary Medicine Budapest, Budapest, Hungary
| | - Andrea Harnos
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Zsolt Molnár
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
- Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Kata Illés
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinkszky Hospital, Budapest, Hungary
| | - Tamás Horváth
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinkszky Hospital, Budapest, Hungary.
| |
Collapse
|
2
|
Xue P, Wang Z, Chai Y, Si M, Hu L. Treatment of congenital middle ear cholesteatoma in children using endoscopic and microscopic ear surgeries: a case series. Front Pediatr 2024; 12:1336183. [PMID: 38853779 PMCID: PMC11157046 DOI: 10.3389/fped.2024.1336183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/29/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Surgical removal is widely employed in children with congenital middle ear cholesteatoma (CMEC). Here, we report the surgical outcomes of CMEC removal via endoscopic ear surgery (EES) and microscopic ear surgery (MES) in children. Methods Children with CMEC who underwent preoperative medical history inquiry, hearing test, endoscopic evaluation, and radiology imaging before receiving EES or MES were included. Postoperative audiological outcomes and recurrence rates were collected. Results Seventeen children (20 ears) with stage II-IV CMEC were included. Of those, 11 ears (55.0%) underwent EES, and 9 ears (45.0%) underwent MES. The follow-up time was 35 ± 13.5 months. One child in the EES group with stage III CMEC had a recurrence during the follow-up period. In the EES group, the average minimum diameter of the external auditory canal on the affected side was 5.8 mm (4.3-8.0 mm). No linear association was found between age and the minimum diameter of the external auditory canal. Discussion EES is a promising treatment option for children with early-stage CMEC because of its low recurrence rate and minimally invasive nature. The minimum diameter of the external auditory canal on the affected side should be meticulously examined when performing EES in children.
Collapse
Affiliation(s)
- Po Xue
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Zhaoyan Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Yongchuan Chai
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Mingjue Si
- Department of Radiology, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingxiang Hu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| |
Collapse
|
3
|
Brar S, Wolf DM, Faoury M, Barwell J, Saggar A, Daya H. Monozygotic twins and cholesteatomas: nature or nuture? Eur Arch Otorhinolaryngol 2023; 280:5649-5654. [PMID: 37737872 DOI: 10.1007/s00405-023-08239-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Cholesteatoma is a rare middle ear pathology. It can be classified into acquired and congenital forms. Although benign, cholesteatomas can cause significant morbidity including hearing loss, infection, facial palsy and thrombosis. Congenital cholesteatomas are incredibly rare and bilateral disease has not commonly been published in the literature. METHOD We describe the case of female identical (monozygotic, monochorionic, diamniotic) twins who both developed congenital cholesteatomas. In this report, we review the aetiology, treatment, embryology and pathology of cholesteatoma. RESULTS The patients have been followed up 15 years after their initial surgery with promising results - pure-tone audiometry and repeat scans have not illustrated any disease recurrence. CONCLUSION This paper presents one of the only cases of female monozygotic twins presenting with unilateral and bilateral cholesteatomas.
Collapse
Affiliation(s)
- Sabrina Brar
- Department of Otolaryngology, St George's University Hospital, London, UK.
| | - Dennis M Wolf
- Department of Otolaryngology, St George's University Hospital, London, UK
| | - Morad Faoury
- Department of Otolaryngology, St George's University Hospital, London, UK
| | - Julian Barwell
- Department of Genetics, St George's University Hospital, London, UK
| | - Anand Saggar
- Department of Genetics, St George's University Hospital, London, UK
| | - Hamid Daya
- Department of Otolaryngology, St George's University Hospital, London, UK
| |
Collapse
|
4
|
Lou Z. Acquired Cholesteatomas Behind Intact Tympanic Membranes of Adults: A Series of 13 Cases. EAR, NOSE & THROAT JOURNAL 2023:1455613231193542. [PMID: 37596947 DOI: 10.1177/01455613231193542] [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: 08/21/2023] Open
Abstract
Background and Objective: Acquired cholesteatomas behind intact tympanic membrane (ITMC) are rarely encountered in adults in the otology clinic, and the clinical and imaging features of ITMC in adults remain unclear to date. ITMC patients are commonly overlooked because of the absence of both a typical retraction pocket and a tympanic membrane (TM) perforation. The objective of this study was to describe clinical features, pathogenesis, and surgical outcomes in a series of adult patients with acquired ITMC. Materials and Methods: The clinical records of 13 adult patients diagnosed with ITMC were retrospectively reviewed. ITMC were classified into those associated with otitis media with effusion (OME; Group A) and histories of previous perforations (Group B). Results: A total of 13 cases with unilaterally acquired ITMC were included, of which 10 (76.9%) were in Group A and 3 (23.1%) were in Group B. All Group A patients exhibited white masses behind intact TMs, in the anterosuperior quadrants of 6 and the posterior upper quadrants of 4. In Group B patients, white masses in the middle ear were lacking. The TMs were atrophic and white myringosclerotic plaques were evident. The cholesteatomas were confined to the antrum and aditus ad antrum in 2 Group B patients but extended to the epitympanum in 1. All 10 Group A patients had extensive cholesteatomas but intact (noneroded) malleoli. Conclusions: An acquired ITMC should be suspected if symptoms worsen or new symptoms develop in adults with OME or a history of perforation, although the TM is intact with or without pars flaccida retraction, computed tomography/magnetic resonance imaging should be performed. Canal wall up mastoidectomy combined with ventilation tube insertion effectively treated ITMC associated with OME.
Collapse
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu city, Zhejiang provice, China
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Guo L, Su Y, Cai Z, Yang Y. Outcomes of transcanal endoscopic middle ear surgery for congenital cholesteatoma. Acta Otolaryngol 2023; 143:141-146. [PMID: 36825840 DOI: 10.1080/00016489.2023.2176544] [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: 02/25/2023]
Abstract
BACKGROUND Transcanal endoscopic surgery offers advantages for congenital cholesteatoma (CC) which is expanding cystic mass located on an intact tympanic membrane. OBJECTIVES To determine the efficacy of transcanal endoscopic ear surgery for the treatment of CC. MATERIAL AND METHODS Eleven patients with CC confined to the middle ear underwent transcanal endoscopic ear surgery by surgeons who were skilled in otoscopic surgery. According to the Potsic classification, four, three, and four patients had lesions in stages 1, 2, and 3, respectively. The mean follow-up duration was 24.5 months. We retrospectively analyzed the recurrence rate, complications, and average hearing thresholds of the patients with CC. RESULTS All CCs were successfully resected via the transcanal endoscopic approach, without any immediate or serious complications. The only complication was external auditory canal stenosis due to postoperative scarring, which occurred in a patient with a stage-3 cholesteatoma that recurred and required reoperation and second-stage ossicular chain reconstruction. Two more patients underwent one-stage ossicular chain reconstruction. All three patients received a total artificial ossicular replacement prosthesis, and two of them also received cartilage grafts. CONCLUSIONS AND SIGNIFICANCE Transcanal endoscopic ear surgery is an effective method to treat CC belonging to Potsic stages 3 or below.
Collapse
Affiliation(s)
- Lianrong Guo
- Department of Otolaryngology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yongjin Su
- Department of Otolaryngology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Zhi Cai
- Department of Otolaryngology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yuanyuan Yang
- Department of Otolaryngology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| |
Collapse
|
8
|
Reuven Y, Raveh E, Ulanovski D, Hilly O, Kornreich L, Sokolov M. Congenital cholesteatoma: Clinical features and surgical outcomes. Int J Pediatr Otorhinolaryngol 2022; 156:111098. [PMID: 35255443 DOI: 10.1016/j.ijporl.2022.111098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/17/2022] [Accepted: 03/01/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES A typical presentation of congenital cholesteatoma (CC) is asymmetric conductive hearing loss (CHL). As CHL is usually associated with middle ear effusion, diagnosis of CC is frequently delayed. This study aimed to describe the clinical characteristics, treatment and outcomes of children with CC. METHODS The medical files of children diagnosed with CC at a large tertiary pediatric medical center during 2000-2019 were reviewed. The primary outcome measures were: presenting symptoms, surgical findings, stage of disease, recurrence rate and hearing outcome. Imaging findings and the size of mastoid air cells were assessed in CT scans. RESULTS Thirty-nine children were diagnosed with CC. The presenting symptom was unilateral CHL in 85%, with an average speech reception threshold of 41.5 ± 13.7 dB in the affected ear. The mean time from first symptoms to diagnosis was 1.3 years. The surgical approach was exploratory tympanotomy in 25% and canal wall up mastoidectomy in 69%. Seventy percent of the children presented with Potsic stage III-IV. The mean postoperative speech reception threshold was 26.4 ± 12.2 dB (P = 0.002). Recurrence of cholesteatoma occurred in 38% of the patients, mostly in stage III-IV. Mastoid air cell size was significantly smaller on the affected than the unaffected side. CONCLUSIONS In children with persistent unilateral or asymmetric conductive hearing loss, CC should be suspected. Late diagnosis of CC is associated with a high recurrence rate. This highlights the need to promote awareness to the disease among primary physicians in the community health care system.
Collapse
Affiliation(s)
- Yonatan Reuven
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eyal Raveh
- Department of Otorhinolaryngology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Ulanovski
- Department of Otorhinolaryngology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Hilly
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liora Kornreich
- Department of Otorhinolaryngology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meirav Sokolov
- Department of Otorhinolaryngology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Zhao M, Chen BJ, Zhao WD, Li Y, Du Q, Yu J, Wang XW, Qian XQ, Yuan YS, Yang JM, Chi FL, Ren DD. Concurrent Occurrence of Congenital Ossicular Anomaly and Localized Cholesteatoma: Series of 10 Cases. ORL J Otorhinolaryngol Relat Spec 2020; 82:139-149. [PMID: 32203956 DOI: 10.1159/000506206] [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: 10/04/2019] [Accepted: 01/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study is to describe the clinical features, managements and outcomes of a rare coexistence of congenital ossicular anomaly and localized cholesteatoma. A literature review on these cases and each congenital disorder is also presented. METHODS A retrospective chart review was performed on patients diagnosed with congenital ossicular anomaly with concurrent localized cholesteatoma from 2008 to 2017. Clinical data of these patients were collected. RESULTS A total of 10 patients were identified. All patients presented with unilateral hearing loss. Pure-tone audiometry showed conductive hearing loss in all affected ears with an average air conduction (AC) threshold of 59 dB. High-resolution computed tomography scans of the temporal bone diagnosed ossicular anomaly for 90% (9/10); however, only 50% (5/10) had a diagnosis of localized cholesteatoma. A transcanal exploratory tympanotomy under the microscope was performed to discover whether the localized tiny-sized cholesteatoma around the ossicular chain did not have direct contact with the ossicular chain, which could be diagnosed as congenital cholesteatoma. We removed the localized cholesteatoma and reconstructed the ossicular chain in each patient. All localized cholesteatomas were found in the posterior-superior quadrant of the middle ear. Ossicular chain anomalies were associated with the incus and/or the stapes in all cases. Hearing improvement was achieved in each of the 6 patients who were followed up postoperatively, with an average AC threshold of 35 dB. The clinical features of congenital ossicular anomaly with concurrent congenital cholesteatoma were compared with those of each congenital disorder. The pathogenesis of each condition was also discussed. CONCLUSIONS Congenital ossicular anomaly with concurrent congenital cholesteatoma is rare. It shares similar clinical features with congenital ossicular anomaly occurring alone, therefore awareness should be raised for a possible concurrent congenital cholesteatoma which was easy to miss in the diagnosis (50%) by the radiologist. A patient's hearing level can be improved by removal of the cholesteatoma and reconstruction of the ossicular chain. Localized cholesteatoma does not usually show residuals or recurrence.
Collapse
Affiliation(s)
- Meng Zhao
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.,Shanghai Auditory Medical Center, Shanghai, China.,Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Bin-Jun Chen
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.,Shanghai Auditory Medical Center, Shanghai, China.,Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Wei-Dong Zhao
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.,Shanghai Auditory Medical Center, Shanghai, China.,Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Yike Li
- Department of Otolaryngology, Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Qiang Du
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.,Shanghai Auditory Medical Center, Shanghai, China.,Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Jing Yu
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.,Shanghai Auditory Medical Center, Shanghai, China.,Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Xin-Wei Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.,Shanghai Auditory Medical Center, Shanghai, China.,Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Xiao-Qing Qian
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.,Shanghai Auditory Medical Center, Shanghai, China.,Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Ya-Sheng Yuan
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.,Shanghai Auditory Medical Center, Shanghai, China.,Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Juan-Mei Yang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.,Shanghai Auditory Medical Center, Shanghai, China.,Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Fang-Lu Chi
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China, .,Shanghai Auditory Medical Center, Shanghai, China, .,Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China,
| | - Dong-Dong Ren
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.,Shanghai Auditory Medical Center, Shanghai, China.,Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| |
Collapse
|
12
|
Anikin IA, Knyazev AD, Khamgushkeeva NN, Bokuchava TA. CONGENITAL CHOLESTEATOMA OF THE TEMPORAL BONE: ISSUES ASSOCIATED WITH ITS ETIOLOGY, DIAGNOSTICS AND TREATMENT (A LITERATURE REVIEW). ACTA ACUST UNITED AC 2019. [DOI: 10.25207/1608-6228-2019-26-1-158-167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This article provides a brief literature review on congenital cholesteatoma of the temporal bone. Existing theories describing the development of this pathology are analysed. The diagnostic criteria of congenital cholesteatoma are presented, along with a comparative analysis of the characteristics of various instrumental research methods used in the verification of this disease. Issues involved with the surgical management of such patients are considered.A conclusion is made that, due to the rare occurrence of the congenital cholesteatoma of the temporal bone, diverse theories of its etiology, the lack of clear criteria for its diagnostics, this pathology requires further research to elucidate the nature of the disease and identify the risk groups of its occurrence.Conflict of interest: the authors declare no conflict of interest.
Collapse
Affiliation(s)
- Igor’ A. Anikin
- Saint Petersburg Research Institute of Ear, Throat, Nose, and Speech
| | - Anton D. Knyazev
- Saint Petersburg Research Institute of Ear, Throat, Nose, and Speech
| | | | | |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Endoscopic visualization to the anterior surface of the malleus and tensor tympani tendon in congenital cholesteatoma. Eur Arch Otorhinolaryngol 2018; 275:1069-1075. [PMID: 29508055 DOI: 10.1007/s00405-018-4917-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE This study evaluated the feasibility of endoscopy in exposing the anterior surface of the malleus and tensor tympani tendon (ASMT) in children with congenital cholesteatoma (CC), and investigated the outcomes of hearing, postoperative complications, and residual or recurrent disease in endoscopic surgical approach cases. METHODS A retrospective case review was performed in one tertiary referral center. Twelve children with CC involving the ASMT were recruited, and their medical records were reviewed. All patients underwent either total endoscopic surgery (n = 3) or endoscope-assisted surgery (n = 9), and Potsic staging was adopted to classify CC according to its severity: stage I (n = 8), stage II (n = 2), and stage III (n = 2). The mean follow-up period was 15.5 ± 2.8 months. The visibility of the ASMT by endoscope assistance, audiological results, surgical and postoperative complications, and recidivism of CC were analyzed. RESULTS The ASMT was well visualized by endoscope assistance in all cases. No patient showed hearing deterioration at 3 months after surgery, and none experienced residual or recurrent disease during the follow-up period. Postoperative complications were not observed. CONCLUSIONS Total endoscopic or endoscope-assisted surgery could help surgeons directly visualize the ASMT in children, with negligible risks of hearing deterioration, postoperative complications, and recurrent disease. Our study might suggest that endoscopic ear surgery should be considered in patients with CC in the ASMT.
Collapse
|
15
|
Ruben RJ, Bagger-Sjoback D, Downs MP, Gravel JS, Karakashian M, Klein JO, Morizono T, Paparella MM. 8. Complications and Sequelae. Ann Otol Rhinol Laryngol 2016. [DOI: 10.1177/00034894890980s412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
16
|
Mierzwinski J, Fishman AJ, Grochowski T, Drewa S, Drela M, Winiarski P, Bielecki I. Cochlear implant and congenital cholesteatoma. J Otolaryngol Head Neck Surg 2016; 45:8. [PMID: 26829926 PMCID: PMC4736255 DOI: 10.1186/s40463-016-0119-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The occurence of cholesteatoma and cochlear implant is rare. Secondary cholesteatomas may develop as a result of cochlear implant surgery. Primarily acquired cholesteatoma is not typically associated with congenital sensorineural hearing loss or cochlear implant in children. The occurrence of congenital cholesteatoma during cochlear implant surgery has never been reported before, partly because all patients are preoperatively submitted to imaging studies which can theoretically exclude the disease. CASE PRESENTATION We have reported a rare case of congenital cholesteatoma, found during sequential second side cochlear implantation in a 3-year-old child. The child underwent a computed tomography (CT) scan and magnetic resonance imaging (MRI) at 12 months of age, before the first cochlear implant surgery, which excluded middle ear pathology. The mass was removed as an intact pearl, without visible or microscopic violation of the cholesteatoma capsule. All the areas where middle ear structures were touching the cholesteatoma were vaporized with a laser and the cochlear implant was inserted uneventfully. Further follow-up excluded residual disease. CONCLUSION We believe that primary, single stage placement of a cochlear implant (CI) with simultaneous removal of the congenital cholesteatoma can be performed safely. However, to prevent recurrence, the capsule of the cholesteatoma must not be damaged and complete laser ablation of the surface, where suspicious epithelial cells could remain, is recommended. In our opinion, cholesteatoma removal and cochlear implantation should be staged if these conditions are not met, and/or the disease is at a more advanced stage. It is suspected, that the incidence of congenital cholesteatoma in pediatric CI candidates is much higher that in average pediatric population.
Collapse
Affiliation(s)
- J Mierzwinski
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Chodkiewicza 44, 85-667, Bydgoszcz, Poland.
| | - A J Fishman
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Chodkiewicza 44, 85-667, Bydgoszcz, Poland.
| | - T Grochowski
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Chodkiewicza 44, 85-667, Bydgoszcz, Poland.
| | - S Drewa
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Chodkiewicza 44, 85-667, Bydgoszcz, Poland.
| | - M Drela
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Chodkiewicza 44, 85-667, Bydgoszcz, Poland.
| | - P Winiarski
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Bydgoszcz, Ujejskiego 52, 85-168, Bydgoszcz, Poland.
| | - I Bielecki
- Department of Pediatric Otolaryngology, University Children's Hospital of Katowice, ul Medyków 16, 40-752, Katowice, Poland.
| |
Collapse
|
17
|
Minovi A, Dazert S. Diseases of the middle ear in childhood. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc11. [PMID: 25587371 PMCID: PMC4273172 DOI: 10.3205/cto000114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Middle ear diseases in childhood play an important role in daily ENT practice due to their high incidence. Some of these like acute otitis media or otitis media with effusion have been studied extensively within the last decades. In this article, we present a selection of important childhood middle ear diseases and discuss the actual literature concerning their treatment, management of complications and outcome. Another main topic of this paper deals with the possibilities of surgical hearing rehabilitation in childhood. The bone-anchored hearing aid BAHA(®) and the active partially implantable device Vibrant Soundbridge(®) could successfully be applied for children. In this manuscript, we discuss the actual literature concerning clinical outcomes of these implantable hearing aids.
Collapse
Affiliation(s)
- Amir Minovi
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany
| |
Collapse
|
18
|
Congenital Intralabyrinthine Cholesteatoma. Case Rep Otolaryngol 2014; 2014:172162. [PMID: 25057421 PMCID: PMC4099148 DOI: 10.1155/2014/172162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/21/2014] [Indexed: 11/25/2022] Open
Abstract
A patient with a congenital intralabyrinthine cholesteatoma is presented. High-resolution computerized tomographic scans and intraoperative photomicrographs display features of intralabyrinthine extension. We discuss pathogenetic theories for the development of congenital intralabyrinthine cholesteatoma. The distinction of this condition from congenital cholesteatoma with labyrinthine erosion is discussed.
Collapse
|
19
|
Congenital Cholesteatoma of Temporal Bone with Bezold's Abscess: Case Report. Indian J Otolaryngol Head Neck Surg 2013; 64:97-9. [PMID: 23449632 DOI: 10.1007/s12070-011-0226-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 10/18/2009] [Indexed: 10/18/2022] Open
Abstract
Congenital cholesteatoma is a rare entity. It may originate at various sites in the temporal bone, for example, in the petrous apex, the cerebellopontine angle, the middle ear cavity, the mastoid process or in the external auditory canal. The least common site being the mastoid process. Most common presentation is a retrotympanic pearly white mass with no previous history of ear discharge, perforation or any ear surgery. It can lead to various complications, both intracranial and extracranial, some of which may be life threatening. Bezold's abscess is an extracranial complication which is usually seen in children following acute otitis media with mastoiditis. Here we present a rare case of a 60 year old patient with congenital cholesteatoma complicating to Bezold's abscess. After necessary investigations patient underwent surgery for complete removal of cholesteatoma and the abscess drainage.
Collapse
|
20
|
Kim YH, Yoo JC, Lee JH, Oh SH, Chang SO, Koo JW, Kim CS. Stage progression of congenital cholesteatoma in children. Eur Arch Otorhinolaryngol 2011; 269:833-7. [PMID: 21898088 DOI: 10.1007/s00405-011-1737-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 07/22/2011] [Indexed: 10/17/2022]
Abstract
This study aimed to investigate the most prevalent stage in each age-group of children with congenital cholesteatoma (CC) and verify the correlation between the stage and the age of the patients for the type of CC ("closed" keratotic cyst and "open" infiltrative types). Patients diagnosed with CC between 2004 and 2009 (n = 156; 116 boys and 40 girls; mean age, 5 years and 5 months; range, 12 months-16 years and 7 months) were enrolled retrospectively. Assessment of stage and type of CC was performed with preoperative high-resolution temporal bone computed tomography and intraoperative findings. The stage of CC was determined using Potsic's staging system classified into four stages according to ossicular involvement and mastoid extension. The patients consisted of groups divided on the basis of a 2-year interval. The prevalence of stage I began to decline from the age-group of 1-2 years. In contrast, the prevalence of stages III increased from the age-group of 3-4 years and that of stage IV from the age-group 5-6 years. The prevalence of "open" infiltrative type CC increased from approximately the age of 7 years, thus showing some correlation with age but not with stage. The prevalence of CC with the advanced stage increased since the age of 2 years. Therefore, the importance of early diagnosis and treatment of CC should be more emphasized.
Collapse
Affiliation(s)
- Young Ho Kim
- Department of Otolaryngology, Head and Neck Surgery, Seoul Metropolitan Government, Seoul National University, College of Medicine, Boramae Medical Center, 39, Boramae-Gil, Dongjak-Gu, Seoul, 156-707, Korea.
| | | | | | | | | | | | | |
Collapse
|
21
|
Nevoux J, Lenoir M, Roger G, Denoyelle F, Ducou Le Pointe H, Garabédian EN. Childhood cholesteatoma. Eur Ann Otorhinolaryngol Head Neck Dis 2010; 127:143-50. [PMID: 20860924 DOI: 10.1016/j.anorl.2010.07.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although cholesteatoma was first described in 1683, its etiopathogeny remains unexplained. In children, there are two forms: acquired cholesteatoma, resembling the adult form, and congenital cholesteatoma. The acquired form has become less frequent in recent years, thanks to progress in the treatment of childhood otitic pathology. Diagnosis of congenital cholesteatoma, on the contrary, is increasing, due to improvements in information to health care professionals and in diagnostic tools. Clinical and histological evidence points to greater aggressiveness in childhood forms, although this difference cannot, at present, be precisely explained. Diagnosis is clinical, but CT and MR imaging is indispensable for preoperative assessment and postoperative follow-up. New delayed gadolinium-enhanced T1-weighted and diffusion-weighted MRI sequences have recently been developed and provide more precise radiological diagnosis. Treatment is surgical; alternatives, notably by laser, have proved unsuccessful. Complications concern involvement of neighbouring structures, and are mainly infectious; some can be life-threatening, and should be systematically screened.
Collapse
Affiliation(s)
- J Nevoux
- Inserm U, hôpital d'enfants Armand-Trousseau, AP-HP, UMPC, université Paris, France.
| | | | | | | | | | | |
Collapse
|
22
|
Inokuchi G, Okuno T, Hata Y, Baba M, Sugiyama D. Congenital Cholesteatoma: Posterior Lesions and the Staging System. Ann Otol Rhinol Laryngol 2010; 119:490-4. [DOI: 10.1177/000348941011900711] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives We described the characteristics of congenital cholesteatoma in Japanese patients and assessed whether the staging system is useful for predicting the rate of residual disease, the need for reexploration, and surgical outcomes. Methods We performed a retrospective chart analysis of 23 consecutive patients with congenital cholesteatoma. Results The proportion of cases with anterior-superior quadrant involvement was significantly lower in the Asian group than in Western patients. The total residual rate was 26%, and there was a positive association between stage and residual rate, ranging from 0% in stage I and II to 44% in stage IV. Canal wall–up tympanomastoidectomy was the most frequent procedure (57%), and 61% had reexploration. Conclusions Congenital cholesteatoma in Asia is less likely to involve the anterior-superior quadrant than in Western patients. The 4-stage system was useful for predicting residual rates, even in patients in whom anterior-superior quadrant involvement was less common. Postoperative hearing was significantly related to the stages. A routine second-look procedure may be unnecessary in the early stages, whereas reexploration would be better performed in advanced stages. Endoscopy might reduce residual disease and the need for reexploration in the near future.
Collapse
Affiliation(s)
- Go Inokuchi
- Department of Otorhinolaryngology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Taeko Okuno
- Department of Otorhinolaryngology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yuko Hata
- Department of Otorhinolaryngology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Miyuki Baba
- Department of Otorhinolaryngology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Daisuke Sugiyama
- Department of Evidence-Based Laboratory Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
23
|
Abstract
Cholesteatomas are abnormal collections of squamous epithelium and keratin debris that usually involve the middle ear and mastoid. Although histologically benign, they have the ability to expand and destroy bone. Cholesteatomas are treated surgically. The success of such surgery is highly dependent on the extent of the lesion. This article presents information and images to aid the general pediatrician in the early recognition of cholesteatomas, both congenital and acquired, in hopes of improving the outcome for children with this treatable disorder.
Collapse
Affiliation(s)
- Glenn Isaacson
- Department of Otolaryngology, Temple University School of Medicine, 3400 N Broad St, Philadelphia, PA 19140, USA.
| |
Collapse
|
24
|
Abstract
The pathogenesis of middle ear cholesteatoma continues to be highly debated. In recent years, there has been a substantial improvement in the understanding of the pathophysiology of this disease. This chapter provides a summary of the history and evolution of cholesteatoma and a review of the recent literature that pertains to the pathophysiology of congenital and acquired cholesteatoma. An emphasis is placed on the mechanism of osteolysis and the factors predictive of aggressiveness and recidivism.
Collapse
Affiliation(s)
- Maroun T Semaan
- Department of Otolaryngology and Head and Neck Surgery, University Hospitals of Cleveland, Case Western Reserve University, LKS 4500, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | | |
Collapse
|
25
|
Olszewska E, Wagner M, Bernal-Sprekelsen M, Ebmeyer J, Dazert S, Hildmann H, Sudhoff H. Etiopathogenesis of cholesteatoma. Eur Arch Otorhinolaryngol 2004; 261:6-24. [PMID: 12835944 DOI: 10.1007/s00405-003-0623-x] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2003] [Accepted: 04/03/2003] [Indexed: 11/26/2022]
Abstract
Cholesteatoma is a destructive lesion of the temporal bone that gradually expands and causes complications by erosion of the adjacent bony structures. Bone resorption can result in destruction of the ossicular chain and otic capsule with consecutive hearing loss, vestibular dysfunction, facial paralysis and intracranial complications. Surgery is the only treatment of choice. The etiopathogenesis of cholesteatoma, however, is still controversial. This review was designed to understand the reasons for these disparities and to reduce or eliminate them. Future studies focused on developmental, epidemiological, hormonal and genetic factors as well as on treatment are likely to contribute to further understanding of cholesteatoma pathogenesis.
Collapse
Affiliation(s)
- Ewa Olszewska
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical Academy, Bialystok, Poland
| | | | | | | | | | | | | |
Collapse
|
26
|
El-Bitar MA, Choi SS. Bilateral occurrence of congenital middle ear cholesteatoma. Otolaryngol Head Neck Surg 2002; 127:480-2. [PMID: 12447250 DOI: 10.1067/mhn.2002.128898] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Mohamed A El-Bitar
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Children's National Medical Center, George Washington University, Washington, DC 20010, USA
| | | |
Collapse
|
27
|
Potsic WP, Korman SB, Samadi DS, Wetmore RF. Congenital cholesteatoma: 20 years' experience at The Children's Hospital of Philadelphia. Otolaryngol Head Neck Surg 2002; 126:409-14. [PMID: 11997782 DOI: 10.1067/mhn.2002.123446] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We report our experience with congenital cholesteatoma over a span of 20 years with an emphasis on presenting characteristics and predictors of outcome. METHODS We conducted a retrospective review from 1981 through 2000. RESULTS One hundred seventy-two congenital cases were identified in 167 patients. Five patients had bilateral disease. The majority (72%) were found in boys, with an average age of 5.0 years. Hearing loss was slight to moderate. When confined to 1 quadrant, cholesteatoma was anterosuperior in 82% of cases; 47% had cholesteatoma in 2 or more quadrants. Ossicular chain involvement was found in 43% of all cases, and mastoid extension was evident in 23%. The rate of recurrent disease was directly related to the extent and number of quadrants involved. CONCLUSION To our knowledge, this is the largest series of congenital cholesteatomas to be reported. This review confirms the male predominance and predilection for the anterosuperior quadrant. The extent of cholesteatoma and its relation to residual disease should be used as a guide for planning a second-look procedure.
Collapse
Affiliation(s)
- William P Potsic
- The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, 19104, USA.
| | | | | | | |
Collapse
|
28
|
Darrouzet V, Duclos JY, Portmann D, Bebear JP. Congenital middle ear cholesteatomas in children: our experience in 34 cases. Otolaryngol Head Neck Surg 2002; 126:34-40. [PMID: 11821763 DOI: 10.1067/mhn.2002.121514] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate clinical data, extensions, residual disease rate, and functional results in cases of congenital cholesteatoma in pediatric patients compared with cases of acquired forms. STUDY DESIGN AND SETTING In a retrospective study conducted at a single tertiary care center over a decade, 34 congenital cholesteatomas (mean patient age, 6.6 years) isolated from a series of 215 cholesteatomas in children were treated surgically and followed up for an average of 83 months. Surgical treatment consisted of the closed technique (CT), open technique tympanoplasty in CT [TOT], radical mastoidectomy (RM), or Rambo's technique. The main outcome measures were surgical findings, residual lesion rate, and hearing assessment. RESULTS The first surgical procedure was CT in 85.3%, TOT in 8.8%, RM in 2.9%, and Rambo's technique in 2.9% of patients. Two, 3, and 4 operations were necessary in 76.5%, 11.4%, and 11.4% of children, respectively. Residual lesions were observed in 34.6% of those multi-operated patients (7 CT and 2 TOT), 24.1% in those treated with CT, and 29.2% in those treated with CT with a planned second look. Mean postoperative pure tone average and air-bone gap were 26 and 21 dB, respectively. A speech reception threshold of less than 30 dB HL was achieved in 66% of patients. A total of 26 ossiculoplasties had to be performed (8 partial and 18 total); the mean postoperative air-bone gap was lower after the former (15 dB) than after the latter (22 dB). A high-frequency pure-tone hearing loss of more than 10 dB was uncommon (5.8%). Unsurprisingly, the residual lesion rate seems to be higher for congenital than for acquired cholesteatomas, but hearing results are significantly better. CONCLUSION In most cases, staged CT appears to be the best technique to treat these lesions, which often develop in a well-pneumatized mastoid.
Collapse
Affiliation(s)
- Vincent Darrouzet
- Department of Otorhinolaryngology, University Hospital of Bordeaux, France.
| | | | | | | |
Collapse
|
29
|
Edelstein DR, Parisier SC, Ahuja GS, Juarbe C, Chute P, Wenig S, Kaye SM. Cholesteatoma in the pediatric age group. Ann Otol Rhinol Laryngol 1988; 97:23-9. [PMID: 3277523 DOI: 10.1177/000348948809700105] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The diagnosis and management of cholesteatoma in children remains controversial. In the past 15 years, the senior author (S.C.P.) has treated 320 patients with cholesteatoma. Patients 18 years and younger composed 40% (125) of the overall group and are the basis for this report. The patient data were compiled using the history, physical examination, audiograms, radiographs, patient questionnaires, surgical findings, and postoperative observations. The surgical treatment selected was determined by the extent of disease, the configuration of the mastoid, and a clinical assessment of eustachian tube function. A middle ear tympanotomy approach was used in 17% of the patients, a canal wall up procedure in 31%, and a canal wall down procedure in 52.3%. The average clinical follow-up was 3.9 years, with the range being from 3 months to 13.5 years. Hearing was maintained or slightly improved in a majority of cases. Residual disease occurred in 8% of patients, and recurrent disease in only 3%.
Collapse
Affiliation(s)
- D R Edelstein
- Department of Otolaryngology-Head and Neck Surgery, Manhattan Eye, Ear and Throat Hospital, New York, NY 10021
| | | | | | | | | | | | | |
Collapse
|