1
|
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.
Collapse
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
| |
Collapse
|
2
|
Zeng N, Liang M, Yan S, Zhang L, Li S, Yang Q. Transcanal endoscopic treatment for congenital middle ear cholesteatoma in children. Medicine (Baltimore) 2022; 101:e29631. [PMID: 35866811 PMCID: PMC9302349 DOI: 10.1097/md.0000000000029631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
To investigate the feasibility and efficacy of transcanal endoscopic treatment for congenital middle ear cholesteatoma in children. Eleven children diagnosed with congenital middle ear cholesteatoma, who underwent total ear endoscopic surgery under general anesthesia, were included from the Huazhong University of Science and Technology Union Shenzhen Hospital between January 2016 and December 2020. We retrospectively analyzed their operation process and surgical complications through the surgical video; moreover, we compared the pre- and postoperative hearing outcomes. One child underwent a planned second operation to reconstruct the ossicular chain. At 6 postoperative months, all 11 children underwent reexamination. There was no significant change and a significant decrease in the mean bone and air conduction hearing thresholds, respectively (P > .05 and P < .05); moreover, there was a significant reduction in the air-bone conduction difference (P < .05). Further, the air-bone conduction difference was reduced to >20 dB and >10 dB in 11 and 7 children, respectively. Follow-up of the children did not reveal sensorineural deafness, facial paralysis, and other serious complications; further, there were no cases of recurrence. Transcanal endoscopic treatment for congenital middle ear cholesteatoma in children is feasible, minimally invasive, and functional.
Collapse
Affiliation(s)
- Nan Zeng
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
| | - Meng Liang
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, People’s Republic of China
| | - Shang Yan
- Department of Otolaryngology, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Lue Zhang
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
| | - Shuo Li
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
- *Correspondence: Shuo Li, Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, Guangdong, China (e-mail: )
| | - Qiong Yang
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
| |
Collapse
|
3
|
Zelenkova VN, Zelenkov AV, Kryukov AI, Stepanova EA, Moseykina LA. [Congenital cholesteatoma of the mastoid process: cases of diagnosis and surgical treatment]. Vestn Otorinolaringol 2022; 87:95-101. [PMID: 36107188 DOI: 10.17116/otorino20228704195] [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] [Indexed: 06/15/2023]
Abstract
A brief review of the epidemiology and pathogenesis of congenital cholesteatoma (CC) of the temporal bone pyramid is presented, classifications reflecting the degree of spread or localization of the process are considered. Variants of local CCs of the mastoid process don't fit into these classifications, as well as there is no statistics on the frequency of their detection and treatment due to the rarity of this pathology. Clinical cases of diagnosis, surgical treatment of CC of the mastoid process and its results are described. Clinical examples indicate a long-term asymptomatic course of CC of the mastoid process, accompanied by a pronounced destructive process in the mastoid process. Early surgical treatment makes it possible to remove the neoplasm as radically as possible and preserve hearing function.
Collapse
Affiliation(s)
- V N Zelenkova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A V Zelenkov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E A Stepanova
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - L A Moseykina
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| |
Collapse
|
4
|
Maccarrone F, Molinari G, Alberici MP, Cesinaro AM, Villari D, Alicandri-Ciufelli M, Tassi S, Negri M. The Tensor Tympani Tendon: A Hypothetical Site of Origin of Congenital Cholesteatoma. Head Neck Pathol 2021; 16:224-228. [PMID: 34106408 PMCID: PMC9018919 DOI: 10.1007/s12105-021-01342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/31/2021] [Indexed: 12/30/2022]
Abstract
Multiple theories have been discussed about the etiopathogenesis of congenital middle ear cholesteatoma (CMEC) and its specific site of origin. The intraoperative identification of the precise location of the keratinous mass is important to guarantee its complete removal, in order to reduce the risk of recurrence. This study proposes the tensor tympani tendon (TTT) as a possible site of origin of CMEC. All CMECs treated between 2013 and 2019 were reviewed. Only Potsic stage I lesions were included. Preoperative radiologic images were compared to intraoperative findings. Three removed TTT were sent for histologic evaluation. Seven patients were included (M:F = 3:4). Preoperative CT images were classified as type A in 2 cases (28.6%) and type B in 5 cases (71.4%). At intraoperative evaluation all CMEC sacs were found pedunculated on the TTT. The histologic examinations confirmed the connection between the cholesteatomatous sac and the TTT. According to the correlation of imaging, intraoperative findings and histology, we proposed that the TTT could be the primary site from which CMEC originates.
Collapse
Affiliation(s)
- Francesco Maccarrone
- Department of Otolaryngology-Head and Neck Surgery, “B. Ramazzini” Hospital of Carpi, Carpi, Italy ,Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Giulia Molinari
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Maria Paola Alberici
- Department of Otolaryngology-Head and Neck Surgery, “B. Ramazzini” Hospital of Carpi, Carpi, Italy
| | | | - Domenico Villari
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | | | - Sauro Tassi
- Department of Otolaryngology-Head and Neck Surgery, “B. Ramazzini” Hospital of Carpi, Carpi, Italy
| | - Maurizio Negri
- Department of Otolaryngology-Head and Neck Surgery, “B. Ramazzini” Hospital of Carpi, Carpi, Italy
| |
Collapse
|
5
|
Zhao YY, Liu P, Liu J, Xie J, Wang GP, Guo JY, Gong SS. Suggestion of a Modified Classification for Congenital Middle Ear Cholesteatoma: Based on the Clinical Characteristics and Staging of Fifty-Seven Patients. Cancer Biother Radiopharm 2020; 36:260-267. [PMID: 32735447 DOI: 10.1089/cbr.2020.3786] [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: 11/12/2022] Open
Abstract
Objective: To explore more refined classification methods of congenital middle ear cholesteatoma (CMEC) based on two existing staging systems. Subjects and Methods: This study involved a retrospective data review of 57 patients (61 ears involved) with CMEC requiring the surgical treatment. Patients were classified into different stages according to Nelson, Potsic, and Modified Nelson staging system. Preoperative data and intraoperative findings were recorded. Results: The mean age at operation was 15 ± 15.04 years with a median of 10 years. The main clinical manifestation was hearing loss (72.13%). CMEC mass was mainly located in the posterior portion of the tympanic cavity (65.57%). No patient was classified into Potsic stage II. The erosion of incus happened in all cases. Patients with Nelson type 2 and type 3 had erosions to the structures out of middle ear, such as dura mater, lateral semicircle canal, and facial canal. Postoperative follow-up time was more than 24 months. Recurrence occurred in four patients (6.56%), all of them in Nelson type 2, who had received canal wall down mastoidectomy (three cases) and canal wall up mastoidectomy (one case). Conclusions: Nelson staging system was more suitable for advanced CMEC patients than Potsic staging system. The rare case of Potsic stage II restricted the application of Potsic staging system. Moreover, since both of two staging systems do not distinguish the type of involved ossicles, the authors recommended to subdivide Nelson type 2 into type 2a and type 2b based on the erosion of the ossicular chain, as well as subdivide Nelson type 3 into type 3a and 3b based on the erosion of structures out of middle ear, which was named as Modified Nelson staging system.
Collapse
Affiliation(s)
- Yuan-Yuan Zhao
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Otolaryngology, Inner Mongolia People's Hospital, Hohhot, China
| | - Pai Liu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiao Liu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Xie
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guo-Peng Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing-Ying Guo
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shu-Sheng Gong
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Chung JH, Lee SH, Park CW, Kim KR, Tae K, Kang SH, Oh YH, Pyo JY. Expression of Apoptotic vs Antiapoptotic Proteins in Middle Ear Cholesteatoma. Otolaryngol Head Neck Surg 2015; 153:1024-30. [DOI: 10.1177/0194599815591810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/27/2015] [Indexed: 11/16/2022]
Abstract
Objectives To explore the role of antiapoptotic and apoptotic processes in the development of cholesteatoma by investigating the expression of an antiapoptotic (c-FLIP) and apoptotic (p53) protein relative to the expression of a proliferation marker (Ki-67). Study Design Basic science study. Setting Tertiary referral center. Subjects and Methods An immunohistochemical investigation was performed on 35 cholesteatoma specimens (21 acquired, 14 congenital) and 10 normal retroauricular skins to evaluate the expression of c-FLIP, p53, and Ki-67. The expression rate of each marker was measured to assess the difference between retroauricular skin and cholesteatoma, as well as between congenital and acquired cholesteatoma. Results c-FLIP expression was significantly higher in the cholesteatoma specimens than in retroauricular skin ( P < .05), while the expression of p53 did not significantly differ between the two. Ki-67 expression in cholesteatoma was significantly higher than in retroauricular skin ( P < .001). The c-FLIP expression rate was positively correlated with that of Ki-67 ( r = 0.47, P = .001), and there was no significant correlation between the expression level of p53 and that of Ki-67 ( r = 0.152, P = .319). In addition, no differences in c-FLIP, p53, and Ki-67 expression rates were evident between congenital and acquired cholesteatoma. Conclusions The upregulation of c-FLIP together with unchanged p53 suggests an altered equilibrium between apoptosis and antiapoptosis, favoring antiapoptosis, and may play a role in the pathogenesis of cholesteatoma.
Collapse
Affiliation(s)
- Jae Ho Chung
- Departments of Otolaryngology–Head and Neck Surgery, School of Medicine, Hanyang University, Seoul, Korea
| | - Seung Hwan Lee
- Departments of Otolaryngology–Head and Neck Surgery, School of Medicine, Hanyang University, Seoul, Korea
| | - Chul Won Park
- Departments of Otolaryngology–Head and Neck Surgery, School of Medicine, Hanyang University, Seoul, Korea
| | - Kyung Rae Kim
- Departments of Otolaryngology–Head and Neck Surgery, School of Medicine, Hanyang University, Seoul, Korea
| | - Kyung Tae
- Departments of Otolaryngology–Head and Neck Surgery, School of Medicine, Hanyang University, Seoul, Korea
| | - Sung-Ho Kang
- Department of Otorhinolaryngology, Konkuk University School of Medicine, Chungju, Korea
| | - Young Ha Oh
- Departments of Pathology, School of Medicine, Hanyang University, Seoul, Korea
| | - Ju Yeon Pyo
- Departments of Pathology, School of Medicine, Hanyang University, Seoul, Korea
| |
Collapse
|
8
|
Comparative analysis of the expression of E-cadherin, β-catenin, and β1 integrin in congenital and acquired cholesteatoma. Eur Arch Otorhinolaryngol 2015; 273:845-51. [PMID: 25864182 DOI: 10.1007/s00405-015-3621-x] [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: 01/14/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
Abstract
E-cadherin, β-catenin, and β1 integrin are important cell adhesion molecules to maintain epithelial structure and function. We investigated the expression of these cell adhesion molecules in cholesteatomas to understand the role of cell-cell and cell-extracellular matrix interaction in cholesteatomas. An immunohistochemical investigation was carried out on 35 cholesteatoma tissue samples (14 congenital, 21 acquired cholesteatomas) and 10 normal retroauricular skin (RAS) tissues which are obtained during middle ear surgery. The expression rate was measured to find out differences between retroauricular skin and cholesteatoma, as well as between congenital and acquired cholesteatoma. E-cadherin expression rate was significantly lower in the cholesteatoma (spinous layer 88.7 ± 17.9 %, granular layer 54.6 ± 22.6 %) than in the RAS (100 %, 74.4 ± 7.4 %) and in the acquired (83.3 ± 19.4 %, 48.1 ± 22.9 %) than in the congenital (96.7 ± 12.0 %, 64.4 ± 18.8 %). β-catenin expression rate was significantly lower in the cholesteatoma (spinous layer 84.1 ± 17.2 %, granular layer 28.7 ± 30.8 %) than in the RAS (100 %, 75.9 ± 6.1 %) and in the acquired (78.1 ± 17.0 %, 17.1 ± 22.3 %) than in the congenital (93.2 ± 13.5 %, 46.1 ± 34.2 %). The expression pattern of β-catenin is similar to that of E-cadherin. In β1 integrin, there was no significant difference of the expression rate between RAS and cholesteatoma, as well as between congenital and acquired cholesteatoma. In conclusion, the expression of E-cadherin and β-catenin is reduced in cholesteatoma, and the reduction is more pronounced in acquired cholesteatoma than in congenital cholesteatoma. Acquired cholesteatomas showed more aggressive characteristics than congenital cholesteatomas in terms of cell-cell adhesion.
Collapse
|
9
|
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.
Collapse
|
10
|
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.
Collapse
|
11
|
Mishiro Y, Katsura H, Kitahara T, Sakagami M. The Recurrence Rate of Pars Tensa Retraction Cholesteatoma and a New Staging System. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijohns.2014.31001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
12
|
Congenital Cholesteatoma Is Predominantly Found in the Posterior-Superior Quadrant in the Asian Population. Otol Neurotol 2013; 34:630-8. [DOI: 10.1097/mao.0b013e31828dae89] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Santhi K, Tang IP, Nordin A, Prepageran N. Congenital cholesteatoma presenting with Luc's abscess. J Surg Case Rep 2012; 2012:rjs026. [PMID: 24968423 PMCID: PMC3855058 DOI: 10.1093/jscr/rjs026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Congenital cholesteatoma (CC) rarely presents with Luc's abscess. As a result of widespread usage of antimicrobial agents, Luc's abscess is hardly encountered in current clinical practice. Herein, we report a case of Luc's abscess as the first presenting symptom in a 5-year-old boy with underlying CC. Patient's clinical findings, radiological investigations and treatment were also discussed.
Collapse
Affiliation(s)
| | - Ing Ping Tang
- ORL Department, University Malaysia Sarawak, Sarawak, Malaysia
| | - Ahamad Nordin
- ORL Department, Queen Elizabeth General Hospital, Sabah, Malaysia
| | | |
Collapse
|
14
|
Lim HW, Yoon TH, Kang WS. Congenital cholesteatoma: clinical features and growth patterns. Am J Otolaryngol 2012; 33:538-42. [PMID: 22361344 DOI: 10.1016/j.amjoto.2012.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/29/2011] [Accepted: 01/12/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The clinical features and patterns of growth, relative to age, were examined in patients with congenital cholesteatoma to investigate disease progression and site of origin. PATIENTS AND METHODS We retrospectively reviewed 72 children younger than 15 years with intraoperatively confirmed congenital cholesteatoma diagnosed using the inclusion criteria of Levenson et al. Patient demographics, history, and otoscopic and operative findings were evaluated. Correlation between mass volumetric and operation age was analyzed in patients with closed-type masses. Parameters of disease extent of middle ear quadrant, ossicular erosion, attic involvement, invasion of the mastoid cavity, and type of mass were assessed relative to age at operation. RESULTS Mean patient age was 63.1 months (range, 20-179 months), with 51 patients (70.8%) being asymptomatic and diagnosed incidentally. Nineteen patients (26.4%) had closed-type cystic masses, and 53 (73.6%) had open-type lesions. The volume of closed-type masses was linearly correlated with age at operation. Logistic regression showed that increased age at operation was associated with a lower proportion of anterosuperior quadrant lesions, resulting in uncertainty about the site of origin. The possibility of open-type masses also increased according to age at operation. CONCLUSION Congenital cholesteatoma shows growth and extension over time. Early detection and intervention are necessary to avoid advanced disease.
Collapse
Affiliation(s)
- Hyun Woo Lim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | | |
Collapse
|
15
|
Giannuzzi AL, Merkus P, Taibah A, Falcioni M. Congenital mastoid cholesteatoma: case series, definition, surgical key points, and literature review. Ann Otol Rhinol Laryngol 2012; 120:700-6. [PMID: 22224310 DOI: 10.1177/000348941112001102] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We evaluate 3 new cases of congenital cholesteatoma confined to the mastoid process, and compare them with cases presented in the literature in order to better define this rare lesion. METHODS We performed a retrospective chart analysis of all congenital cholesteatomas treated surgically in a tertiary referral and skull base center. We performed a complete analysis (history, radiologic, and surgical) of all patients with congenital cholesteatoma confined to the mastoid process; we then performed a literature review and compared our findings with the presented cases. RESULTS The results of preoperative imaging were in line with the surgical findings. The most important surgical issue in this type of lesion was the management of the sigmoid sinus and the jugular bulb. Half of the cases previously reported in the literature appeared not to fulfill the definition criteria of a congenital cholesteatoma of the mastoid process. CONCLUSIONS Congenital cholesteatoma confined to the mastoid process is a rare lesion, and is even more exceptional upon critical review of the literature. Symptoms are often lacking or nonspecific, and although cases have a congenital origin, the diagnosis often is not made until adulthood. A combined congenital cholesteatoma group with middle ear and mastoid features seems to fill in the gap in the definition. Management of the sigmoid sinus and the jugular bulb is the most demanding surgical key point.
Collapse
|
16
|
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
|
17
|
|