1
|
Ma CC, Ceremsak JJ, Wootten CT. Cholesteatoma in the pediatric aerodigestive population. Int J Pediatr Otorhinolaryngol 2024; 181:111984. [PMID: 38781851 DOI: 10.1016/j.ijporl.2024.111984] [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: 03/06/2024] [Revised: 04/30/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To report the prevalence of cholesteatoma and related comorbidities in pediatric aerodigestive patients requiring tracheostomy or airway reconstruction procedures. To use study findings to inform clinical management of these complex patients. METHODS A repository of clinical data drawn from our institution's electronic medical records was queried to identify airway reconstruction (airway) and complex hospital control (control) patient cohorts. Retrospective chart review was then performed to investigate the occurrence of cholesteatoma and related pathologies in these patients, as well as clinical management. RESULTS The prevalence of cholesteatoma in airway and control patients was 6/374 (1.60 %) and 35/30,565 (0.11 %), respectively. The relative risk of cholesteatoma diagnosis in airway patients was 14.01 (95 % CI 6.06-32.14). Airway patients were more likely than control patients to have pressure equalization tube history (relative risk 3.25, 95 % CI 2.73-3.82). Age at cholesteatoma diagnosis and first surgical intervention was younger in airway compared to control patients (5.43 vs. 8.33, p = 0.0182, and 6.07 vs. 8.82, p = 0.0236). However, time from diagnosis to intervention and extent of surgery were similar between the groups. CONCLUSION This is the first study to investigate the prevalence of cholesteatoma in the pediatric aerodigestive population. The relative risk of cholesteatoma diagnosis was found to be 14 times higher in patients with tracheostomy or airway reconstruction history. Underlying eustachian tube and palatal dysfunction are likely contributing factors to the elevated risk. Additionally, cholesteatoma in this population was diagnosed and required surgical intervention at a younger age, which may suggest a more aggressive disease course. Providers should maintain a high degree of suspicion for cholesteatoma in this complex population.
Collapse
Affiliation(s)
- Connie C Ma
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way 7th Floor, Nashville, TN, 37232, United States.
| | - John J Ceremsak
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way 7th Floor, Nashville, TN, 37232, United States
| | - Christopher T Wootten
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way 7th Floor, Nashville, TN, 37232, United States
| |
Collapse
|
2
|
Baudouin R, Simon F, Levy R, Breton S, Alciato L, Talab E, Leboulanger N, Couloigner V, Garabedian EN, Denoyelle F. Early Magnetic Resonance Imaging to Diagnose Residual Cholesteatoma in Children and Benefit of Radiological Rereview. Otolaryngol Head Neck Surg 2023; 169:1631-1638. [PMID: 37264987 DOI: 10.1002/ohn.392] [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: 10/12/2022] [Revised: 04/28/2023] [Accepted: 05/13/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Non-echo-planar diffusion-weighted (DW) magnetic resonance imaging (non-EPI MRI) is the appropriate sequence to detect residual cholesteatoma. In the child, MRI may be clinically useful to determine the timing of the second-look procedure. The aim of this paper was to retrospectively evaluate the performance of early MRI (before the 18th postoperative month) in detecting residual cholesteatoma in children after review by experienced specialized neuroradiologists. STUDY DESIGN Retrospective study. SETTING One university center comparative cohort. METHODS All patients who had a 2-staged procedure for cholesteatoma with an MRI before the second stage from 2010 to 2020 were included and analyzed. Three pediatric neuroradiologists reviewed all the images blinded to the surgical result. RESULTS N = 141 cholesteatoma events (140 children) were included with a mean age at MRI of 10 (±4) years old. Non-EPI MRIs were performed 10.7 (±3.8) months after the first-stage surgery and 2.2 (±2.6) months before the second-stage procedure. Non-EPI MRI had a 0.57 sensitivity (SE) and 0.83 specificity (SP). MRI was reviewed in 112 cases. The diagnosis was corrected in 17 cases (15.1%) (3 true positives, 7 false negatives, and 7 false positives). SE = 0.63 (p = 0.1) and SP = 0.92 (p = 0.08) after rereading. CONCLUSION Early MRI's SE is poor but SP is excellent after rereading. Evidence does not support the use of early non-EPI MRI to modify the surgical strategy or to postpone the second look. If performed, early non-EPI MRI should be read by specialized experienced radiologists with all 3 sequences (T1, T2, and non-EPI DW) and apparent diffusion coefficient calculation, especially in cases of otitis media with effusion.
Collapse
Affiliation(s)
- Robin Baudouin
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - François Simon
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Raphaël Levy
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Sylvain Breton
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
- Department of Radiology, Paris Imagerie 114, Paris, France
| | - Lauranne Alciato
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Elsa Talab
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicolas Leboulanger
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Couloigner
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Erea-Noël Garabedian
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Françoise Denoyelle
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| |
Collapse
|
3
|
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
|
4
|
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
|
5
|
Muacevic A, Adler JR. Diagnosis and Treatment Modalities of Cholesteatomas: A Review. Cureus 2022; 14:e31153. [PMID: 36505121 PMCID: PMC9731553 DOI: 10.7759/cureus.31153] [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] [Received: 09/15/2022] [Accepted: 11/06/2022] [Indexed: 11/08/2022] Open
Abstract
A cholesteatoma is an abnormal, noncancerous skin growth that can appear beneath the eardrum in the center of your ear. Although it might be a congenital condition, frequent middle ear infections are the main culprit. A cholesteatoma frequently appears as a cyst or sac that exfoliates the skin's outer layers. As these dead skin cells build up, the growth can enlarge and penetrate intratemporal tissues, leading to various intracranial and extracranial difficulties that can compromise facial muscles, hearing, and balance. Cholesteatomas were recognized more than three centuries ago. A cholesteatoma can develop into a serious condition if it is not treated right away. Because of its fast development and invasive nature, it can cause several consequences, some of which can be fatal for people without access to advanced medical treatment. There are no effective nonsurgical treatments available right now. It will be necessary to have a thorough awareness of both previous developments and more current ones to develop an appropriate management approach for this condition. The background information on acquired middle ear cholesteatomas is briefly reviewed in this paper. We also take into account categorization-, epidemiology-, histology-, and pathogenesis-related difficulties, and we carefully review current management and diagnosis approaches.
Collapse
|
6
|
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
|
7
|
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
|
8
|
Cheeney S, Wright JN, Sie KC, Chapman T. Pearls of Temporal Bone Imaging in Children with Hearing Loss. Semin Ultrasound CT MR 2022; 43:3-18. [PMID: 35164907 DOI: 10.1053/j.sult.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hearing loss is one of the most common indications for temporal bone imaging in children. Hearing loss may be congenital or acquired, and it may be conductive, sensorineural, or mixed audiologically. Temporal bone imaging plays an important role in the assessment and management of this condition. An understanding of the embryology of ear structures better enables the radiologist to interpret abnormalities on imaging of the temporal bone. Here, we provide a general review of ear development and a description of known genetic defects that contribute to congenital ear anomalies associated with hearing loss. We provide appropriate imaging techniques for the temporal bone depending on the clinical presentation and a systematic approach to imaging for children with hearing loss. Diagnostic imaging for developmental anomalies of the ear and cholesteatoma will be discussed.
Collapse
Affiliation(s)
- Safia Cheeney
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Jason N Wright
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Kathleen C Sie
- Department of Otolaryngology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Teresa Chapman
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington.
| |
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
|
New Compartmental Reading Method for MRI Enables Accurate Localization of Cholesteatomas With High Sensitivity and Specificity. Otol Neurotol 2021; 42:431-437. [PMID: 33555752 DOI: 10.1097/mao.0000000000002999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cholesteatoma is an inflammatory disease, frequently observed in childrens and young adults, with a risk of relapse or recurrence. The few studies which analyzed cholesteatoma localization on magnetic resonance imaging (MRI) usually merged CT-MR images or relied on their authors' anatomical knowledge. We propose a compartmental reading method of the compartments of the middle ear cavity for an accurate localization of cholesteatomas on MR images alone. MATERIAL AND METHODS Our method uses easily recognizable anatomical landmarks, seen on both computed tomography (CT) and MRI, to delimit the middle ear compartments (epitympanum, mesotympanum, hypotympanum, retrotympanum, protympanum, antrum-mastoid cavity). We first tested it on 50 patients on non-enhanced temporal bone CT. Then, we evaluated its performances for the localization of cholesteatomas on MRI, compared with surgery on 31 patients (validation cohort). RESULTS The selected anatomical landmarks that delimited the middle ear compartments were applicable in 98 to 100% of the cases. In the validation cohort, we were able to accurately localize the cholesteatoma on MRI in 83% of the cases (n = 26) with high sensitivity (95.7%) and specificity (98.6%). CONCLUSION With our compartmental reading method, based on the recognition of well-known anatomical landmarks to differentiate the compartments of the middle ear cavity on MRI, we were able to accurately localize the cholesteatoma with high (>90%) sensitivity and specificity. Such landmarks are widely applicable and only require limited learning time based on key images. Accurate localization of the cholesteatoma is useful for the choice of surgical approach.
Collapse
|
11
|
MacDonald B, Bommakanti K, Mallo M, Carvalho D. Isolated Incudostapedial Cholesteatomas: Unique Radiologic and Surgical Features. EAR, NOSE & THROAT JOURNAL 2020; 100:243S-248S. [PMID: 33237827 DOI: 10.1177/0145561320973785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Congenital cholesteatomas originate from epithelial tissue present within the middle ear in patients with an intact tympanic membrane, no history of otologic surgery, otorrhea, or tympanic membrane perforation. They are diagnosed by a pearl-like lesion on otoscopy and computed tomography (CT) scan showing an expansile soft-tissue mass. We describe a series of patients with no prior otologic history presenting with progressive unilateral conductive hearing loss and normal otoscopy. The CT scans showed ossicular erosion without obvious soft-tissue mass. Surgery confirmed incudostapedial erosion found to be cholesteatoma. In this study, we characterize the clinical course of patients diagnosed with isolated incudostapedial cholesteatoma (IIC) and review possible pathologic mechanisms. METHODS Retrospective review of IIC cases treated by the Department of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, 2014 to 2020. Data included patient demographics, clinical features, imaging, surgical findings, and audiologic data. RESULTS Five patients were diagnosed with IIC (3 [60%] female; mean age at presentation 10.7 years [range 5.5-16.0]). All patients presented with postlingual unilateral conductive hearing loss and normal otoscopy without any past otologic history; delay in diagnosis ranged from 4 months to several years. The CT scans showed ossicular chain erosion with an absent long process of the incus and/or stapes superstructure. All patients underwent middle ear exploration, revealing a thin layer of cholesteatoma in the incudostapedial region, confirmed by histopathology. Mean preoperative speech reception threshold was 55 dB and improved to a mean of 31 dB in the 4 patients who underwent ossicular chain reconstruction. CONCLUSION Isolated incudostapedial cholesteatoma should be included as a possible etiology in pediatric patients with insidious onset of unilateral conductive hearing loss with normal otoscopy, unremarkable otologic history, and a CT scan showing ossicular abnormality/disruption without notable middle ear mass. These patients should be counseled preoperatively regarding the possibility of cholesteatoma and should undergo middle ear exploration with possible ossiculoplasty.
Collapse
Affiliation(s)
- Bridget MacDonald
- School of Medicine, 8784University of California at San Diego, La Jolla, CA, USA
| | - Krishna Bommakanti
- School of Medicine, 8784University of California at San Diego, La Jolla, CA, USA
| | - Moises Mallo
- 70904Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Daniela Carvalho
- School of Medicine, 8784University of California at San Diego, La Jolla, CA, USA.,14444Rady Children's Hospital of San Diego, San Diego, CA, USA
| |
Collapse
|
12
|
Abstract
OBJECTIVE To describe malformations associated with pediatric congenital cholesteatomas of the middle ear. STUDY DESIGN Retrospective study. SETTING Tertiary referral center. PATIENTS One hundred and seventy-three cases of middle ear congenital cholesteatoma (CC) in 171 children operated between 2007 and 2017. INTERVENTIONS Demographic, clinical, and surgical data were collected from operative reports. MAIN OUTCOME MEASURES We first described the type and rate of malformations associated with CC. Secondly, we compared cholesteatoma features in two subgroups: anterior superior (AS) versus posterior superior (PS) starting point. Third, we compared demographic, clinical, and surgical data between patients with and without malformation. RESULTS CC was associated with malformations in 17 cases (17/173; 9.8%). The main malformation was preauricular fistula (8/173; 4.6%). Other malformations were: one first branchial cleft, two labio palatine cleft, one nasal cyst, two preauricular fibrochondroma, and five other malformations. PS congenital cholesteatomas were diagnosed in older children (4.6 versus 8.6 years, p < 0.05) and had greater extension in middle ear than the AS cholesteatoma (39.7% versus 95.8%, p < 0.05). We did not find any significant difference between these two groups regarding the associated malformations. We did not find a difference in clinical presentation of CC between patients with and without associated malformation. CONCLUSIONS We found various associated malformations in 9.8% of CC cases with no statistical difference in the malformation rate between AS and PS groups. All the malformations were located in the craniofacial region suggesting that genes implicated in craniofacial development may play a role in the pathophysiology of CC.
Collapse
|
13
|
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
|
14
|
Lee CH, Kim MK, Kim HM, Won C, Shin TH, Kim SY. Endaural Laser-Assisted Single-Stage Inside-Out Cholesteatoma Surgery (LASIC) to Treat Advanced Congenital Cholesteatoma. Otol Neurotol 2020; 40:927-935. [PMID: 31295203 DOI: 10.1097/mao.0000000000002299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Investigation of endaural laser-assisted single-stage inside-out cholesteatoma surgery (LASIC) to treat advanced congenital cholesteatoma (ACC) by a modified staging system based on ossicle status. STUDY DESIGN A retrospective case review. SETTING A university hospital otology referral clinic. PATIENTS Two hundred consecutive pediatric patients with ACC were enrolled. INTERVENTIONS Endaural LASIC and postoperative temporal bone computed tomography (CT). MAIN OUTCOME MEASURES Residual or recurrent CC and audiological outcomes. RESULTS LASIC was feasible in 98.0% of patients. Single-stage ossiculoplasty was performed in 95.5% of patients. Hearing preservation to less than 20 dB was 59.2% and to the preoperative hearing level was 84.5%. Mastoid invasion did not result in worse recidivism or hearing loss (HL) but further invasion of the stapes superstructure (stage IV) significantly elevated both the recidivism (16.7%) and the risk for HL (to 84.8%) (p = 0.001). Ossicle preservation LASIC was frequently possible in stage III posterior type (75.6%), whereas it was rarely possibly (15.4%) in the anterior type. Incudostapedial joint (ISJ) invasion in the absence of cochleariform process (CP) invasion (III-posterior) did not increase the incidence of HL (6.1%) or recidivism (2.4%). However, simultaneous invasion of the CP and ISJ (III-anterior) elevated the risk of HL by 46.2% by ossicle removal, although recidivism was not increased (3.8%). CONCLUSIONS Endaural LASIC for ACC achieved satisfactory recidivism (overall 7.5%, 16.7% in stage IV) comparable to early CC (17.2%). An ossicle status-based staging system was more efficient for correlation with audiologic and surgical outcomes of CC than that of mastoid invasion.
Collapse
Affiliation(s)
- Chang Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA University College of Medicine, Seongnam, Gyeonggi-do, Republic of Korea
| | | | | | | | | | | |
Collapse
|
15
|
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
|
16
|
Middle ear congenital cholesteatoma: systematic review, meta-analysis and insights on its pathogenesis. Eur Arch Otorhinolaryngol 2020; 277:987-998. [PMID: 31955213 DOI: 10.1007/s00405-020-05792-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/07/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Congenital cholesteatoma (CC) presents as a white pearl-like lesion behind a normal tympanic membrane (TM), without a history of otorrhea, infection, perforation or previous otologic surgery. Several recent studies provided new data improving this pathology characterization. The aim of this paper is to expand the knowledge about CC and to provide new insights on its pathogenesis. METHODS The study consisted of two main research parts: (1) systematic review and meta-analysis; (2) medical literature review englobing anatomy, histology, embryology and congenital pathology of the ear. RESULTS The search strategy identified a total of 636 papers. Seventy retrospective studies were included. A total of 1497 cases were studied and the mean age was 6.58 years, with a male-female ratio of 3:1, 34% were asymptomatic, 26% had hearing loss and 2% had facial dysfunction/paralysis. The overall estimate for antero-superior quadrant involvement was 0.70 [95% confident interval (CI) 0.64-0.76], in the postero-superior quadrant was 0.60 (95% CI 0.52-0.69), in the antero-inferior quadrant was 0.32 (95% CI 0.23-0.41), in the postero-inferior quadrant was 0.38 (95% CI 0.29-0.47), in the attic was 0.53 (95% CI 0.43-0.63) and in the mastoid was 0.33 (95% CI 0.26-0.41). More advanced Potsic stages were present in older patients. The most likely inclusion place seems to be between the pars flaccida and the upper quadrants of the pars tensa. CONCLUSIONS During the last decades, a substantial improvement in CC diagnosis and management had been achieved. The presented mechanism seems to explain most of middle ear CC.
Collapse
|
17
|
Yamamoto-Fukuda T, Akiyama N, Kojima H. Keratinocyte growth factor (KGF) induces stem/progenitor cell growth in middle ear mucosa. Int J Pediatr Otorhinolaryngol 2020; 128:109699. [PMID: 31614241 DOI: 10.1016/j.ijporl.2019.109699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The middle ear epithelium is derived from the neural crest and endoderm, which line distinct regions of the middle ear cavity. In this study, we investigated the localization of stem/progenitor cells in the middle ear mucosa of adult mice and the effects of keratinocyte growth factor (KGF) on the cell kinetics of stem/progenitor cells in vivo. METHODS In this study, after KGF-expression vector was transfected in the ear, two kinds of thymidine analogues, BrdU and EdU, were transferred at different time points. BrdU was detected by immunohistochemistry and EdU was detected by click chemistry. We also performed immunohistochemistry using anti-Keratin14 (K14) antibody (an undifferentiated epithelial cell marker), anti-p63 antibody (a stem/progenitor cell marker) and anti-acetylated α-tubulin antibody (a ciliated epithelial cell marker). RESULTS A large number of EdU-positive cells were detected in the thickened mucosal epithelium of the pars flaccida and attic region at Day 1 after KGF transfection. Interestingly, in the mucosal epithelium overlying the promontory of the cochlea, many EdU-positive cells were detected. These cells were also positive for K14 and p63. The acetylated α-tubulin positive cells were reduced in the attic region at Day 1 after KGF transfection. CONCLUSION These findings indicate that KGF over-expression may increase stem/progenitor cell proliferation in the mucosal epithelium not only within the attic which is typical in middle ear cholesteatoma, but also overlying the promontory of the cochlea.
Collapse
Affiliation(s)
- Tomomi Yamamoto-Fukuda
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan; Department of Histology and Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Naotaro Akiyama
- Department of Histology and Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Otorhinolaryngology, Toho University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
18
|
Volgger V, Lindeskog G, Krause E, Schrötzlmair F. Identification of risk factors for residual cholesteatoma in children and adults: a retrospective study on 110 cases of revision surgery. Braz J Otorhinolaryngol 2019; 86:201-208. [PMID: 31523024 PMCID: PMC9422382 DOI: 10.1016/j.bjorl.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 09/20/2018] [Accepted: 11/10/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction Residual disease after cholesteatoma removal is still a challenge for the otorhinolaryngologist. Scheduled “second-look” surgery and, more recently, radiological screenings are used to identify residual cholesteatoma as early as possible. However, these procedures are cost-intensive and are accompanied by discomfort and risks for the patient. Objective To identify anamnestic, clinical, and surgery-related risk factors for residual cholesteatoma. Methods The charts of 108 patients, including children as well as adults, having undergone a second-look or revision surgery after initial cholesteatoma removal at a tertiary referral hospital, were analyzed retrospectively. Results Gender, age, mastoid pneumatization, prior ventilation tube insertion, congenital cholesteatoma, erosion of ossicles, atticotomy, resection of chorda tympani, different reconstruction materials, and postoperative otorrhea did not emerge as statistically significant risk factors for residual disease. However, prior adenoid removal, cholesteatoma growth to the sinus tympani and to the antrum and mastoid, canal-wall-up 2 ways approach, and postoperative retraction and perforation were associated with a statistically higher rate of residual disease. A type A tympanogram as well as canal-wall-down plus reconstruction 2 ways approach for extended epitympanic and for extended epitympanic and mesotympanic cholesteatomas were associated with statistically lower rates of residual disease. A score including the postoperative retraction or perforation of the tympanic membrane, the quality of the postoperative tympanogram and the intraoperative extension of the cholesteatoma to the sinus tympani and/or the antrum was elaborated and proved to be suitable for predicting residual cholesteatoma with acceptable sensitivity and high specificity. Conclusion Cholesteatoma extension to the sinus tympani, antrum and mastoid makes a residual disease more likely. The canal-wall-down plus reconstruction 2 ways approach seems safe with similar rates of residual cholesteatoma and without the known disadvantages of canal-wall-down surgery. The described score can be useful for identifying patients who need a postoperative radiological control and a second-look surgery.
Collapse
Affiliation(s)
- Veronika Volgger
- Klinikum der Universität München, Department of Otorhinolaryngology, Head & Neck Surgery, München, Germany.
| | - Göran Lindeskog
- Klinikum der Universität München, Department of Otorhinolaryngology, Head & Neck Surgery, München, Germany
| | - Eike Krause
- Klinikum der Universität München, Department of Otorhinolaryngology, Head & Neck Surgery, München, Germany
| | - Florian Schrötzlmair
- Klinikum der Universität München, Department of Otorhinolaryngology, Head & Neck Surgery, München, Germany
| |
Collapse
|
19
|
|
20
|
Is transcanal tympanoplasty an appropriate surgical treatment for congenital middle ear cholesteatoma with ossicular involvement? Int J Pediatr Otorhinolaryngol 2019; 116:102-106. [PMID: 30554678 DOI: 10.1016/j.ijporl.2018.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/18/2018] [Accepted: 10/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aims of this study are to analyze the clinical characteristics of congenital middle ear cholesteatoma (CMC), to evaluate the treatment results according to the types of surgical approach, and to suggest the appropriate surgical treatment option in each stage. METHODS One hundred fifteen children (≤15 years old) with surgically confirmed CMC, who underwent surgery at a tertiary hospital during 1994-2012 and were followed up more than 2 years, were enrolled in this study. CMC was classified into four stages by the staging system proposed by Potsic. Clinical characteristics of CMC were analyzed and its association with the rate of residual disease was evaluated. RESULTS Based on the location of the lesion, posterior-origin CMCs were detected significantly later (5.5 years old, P = 0.018) and more likely to be in the Stage 3 or 4 (P < 0.001). Residual CMCs were observed in 10 out of 115 cases (8.7%) and were more frequent in the Stage 3 or 4 patients (P = 0.007). However, the rate of the residual disease was not statistically different between anterior- and posterior-origin CMCs (P = 0.101). All 58 cases of CMC in the Stage 1 or 2 were successfully removed by transcanal tympanoplasty with only one residual case (1.7%). In the Stage 3 cases, transcanal tympanoplasty was conducted in 24 out of 29 patients, and the residual disease rate was 12.5% (3 out of 24). CONCLUSIONS The early stages of CMC were likely to be diagnosed at younger age, and the early diagnosis seemed to show better surgical outcomes with less invasive techniques. Transcanal tympanoplasty can be an effective surgical option for CMCs in the Stage 3.
Collapse
|
21
|
Ryan PJ, Patel NP. Endoscopic Management of Pediatric Cholesteatoma. J Otol 2018; 15:17-26. [PMID: 32110236 PMCID: PMC7033597 DOI: 10.1016/j.joto.2018.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 12/15/2022] Open
Abstract
Pediatric cholesteatoma occurs in one of two forms: congenital cholesteatoma, developing from embryonic epidermal cell rests or acquired cholesteatoma, associated with a focal defect in the tympanic membrane. This disease has been traditionally managed with the operating microscope, often requiring mastoidectomy for adequate visualization of and access to the middle ear and mastoid cavities. Recently, advances in endoscopic equipment have enabled otologists to manage most cases of pediatric cholesteatoma via a minimally-invasive, transcanal endoscopic approach. This review discusses the current literature relating to the etiopathogenesis, assessment and endoscopic management of pediatric cholesteatoma. Early outcomes of endoscopic treatment, emerging trends and technologies are also reviewed.
Collapse
Affiliation(s)
- Peter J Ryan
- Department of Otolaryngology and Head and Neck Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Nirmal P Patel
- Department of Otolaryngology and Head and Neck Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.,Kolling Deafness Research Centre, Macquarie University and University of Sydney, NSW, Australia
| |
Collapse
|
22
|
Laske RD, Roth TN, Baráth K, Schuknecht B, Huber AM, Röösli C. The Role of Non-Echoplanar Diffusion-Weighted Magnetic Resonance Imaging in Diagnosis of Primary Cholesteatoma and Cholesteatoma Recidivism as an Adjunct to Clinical Evaluation. Ann Otol Rhinol Laryngol 2018; 127:919-925. [DOI: 10.1177/0003489418800833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The aim of this study was to analyze the sensitivity and specificity of non-echoplanar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) for the detection of cholesteatoma, with a focus on its value as an adjunct to clinical examination. Methods: In a prospective cohort study, 92 cases were divided into 2 groups: “clinically cholesteatoma” ( n = 79) and “clinically no cholesteatoma” ( n = 13). Non-EPI DW MRI was performed preoperatively in all cases. The presence of a cholesteatoma was assessed by clinicians otoscopically, by neuroradiologists on non-EPI DW MRI, by the surgeon intraoperatively, and finally by the pathologist postoperatively. Data analysis was performed for specificity, sensitivity, positive predictive value, negative predictive value, and interrater variability. Results: The sensitivity and specificity were 89.3% and 75%, respectively, in the “clinically cholesteatoma” group and 0% and 100% in the “clinically no cholesteatoma” group. Non-EPI DW MRI had a positive predictive value of 98.5% when cholesteatoma was suspected clinically and a negative predictive value of 84.6% when cholesteatoma was not suspected clinically. Conclusion: If cholesteatoma is suspected clinically, non-EPI DW MRI is not necessary. If there is no clinical suspicion of cholesteatoma in second-look situations, sensitivity is low and serial follow-up MRI with long intervals is advised.
Collapse
Affiliation(s)
- Roman D. Laske
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Thomas N. Roth
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | | | | | - Alexander M. Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Christof Röösli
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| |
Collapse
|
23
|
Abstract
OBJECTIVE To examine the risk factors of recurrence in pediatric congenital cholesteatoma. STUDY DESIGN Retrospective chart review. SETTING University hospital. PATIENTS Sixty-seven patients having tympanic type of congenital cholesteatoma under 15-years old at surgery. INTERVENTIONS Canal wall-up tympanomastoidectomy (n = 30) or transcanal atticotomy/tympanoplasty (n = 37) was performed depending on cholesteatoma extension, 16 of which were followed by second-look surgery. Preoperative computed tomography (CT) before second-look surgery or follow-up CT was performed to detect residual recurrence 1 year after the surgery. Cholesteatoma found at the second surgery was also included in the recurrence. All patients had no recurrent cholesteatoma at the last follow-up (median, 61 mo after surgery). MAIN OUTCOME MEASURES Possible predictive factors were compared between the groups. RESULTS Residual cholesteatoma and retraction cholesteatoma occurred in 21 and 6%, respectively. There was no significant difference in age, sex, and type of cholesteatoma (open or closed) between the groups; however, Potsic stage and status of stapes involvement were more advanced in the residual cholesteatoma group. All residual lesions could be detected by follow-up CT or by second-look surgery. All of four retraction cholesteatoma patients were male, young at the surgery and in stage IV. CONCLUSION Recurrence mostly occurred as residual cholesteatoma, suggesting that CT is recommended as a follow-up tool for congenital cholesteatoma. Advanced lesions had the risk of residual cholesteatoma, suggesting that complete removal of epithelium is important. Although rare, young advanced-stage patients had risk of retraction cholesteatoma and therefore normal mucosa should be preserved as much as possible for these patients.
Collapse
|
24
|
|
25
|
Rohlfing ML, Sukys JM, Poe D, Grundfast KM. Bilateral congenital cholesteatoma: A case report and review of the literature. Int J Pediatr Otorhinolaryngol 2018; 107:25-30. [PMID: 29501306 DOI: 10.1016/j.ijporl.2018.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 01/07/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Congenital cholesteatoma (CC) occurs less commonly than acquired cholesteatoma (AC), and bilateral CC (BCC) is even more rare with only 38 such cases having been reported in the past 42 years. Because of the rarity of this condition, providers confronted with cases of BCC may find it difficult to treat while balancing complete removal of disease, optimal hearing outcomes, and minimized surgical burden in the pediatric patient. This review alerts physicians that BCC occurs, highlights past presentations and management strategies, describes the considerations in treatment and offers an algorithm helpful in the management of BCC. METHODS Review of a single case with extensive review of published reports from 1975 to 2017 pertaining to management of BCC. RESULTS A five-year-old boy presented with bilateral congenital cholesteatoma. Tympanomastoidectomy was performed to remove cholesteatoma in the left ear then in the right ear months later. Ossicular chain reconstruction was deferred in both cases. Second look procedures revealed persistent cholesteatoma in both ears. In the descriptions of the 38 published BCC cases, the extent and location of the CC varied widely as did the approach to management. In the 18 cases that had descriptions of surgical management, four had second look procedures. In the 16 reports that described extent of cholesteatoma, 12 had the first of two or more operations on the ear with more extensive cholesteatoma. CONCLUSIONS Risks are increased for recidivism/recurrence and hearing impairment in children with BCC compared to children with unilateral CC. We present a novel algorithm for management of BCC that recommends surgery for cholesteatoma removal first in the more severely affected ear and delayed OCR for both ears. Simultaneous surgery may be considered in certain cases.
Collapse
Affiliation(s)
- Matthew L Rohlfing
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston, MA, United States.
| | - Jordan M Sukys
- Boston University School of Medicine, Boston, MA, United States.
| | - Dennis Poe
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
| | - Kenneth M Grundfast
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston, MA, United States.
| |
Collapse
|
26
|
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
|
27
|
Grauvogel J, Scheiwe C, Masalha W, Grauvogel T, Kaminsky J, Vasilikos I. Piezosurgery-, neuroendoscopy-, and neuronavigation-assisted intracranial approach for removal of a recurrent petrous apex cholesteatoma: technical note. J Neurosurg Pediatr 2018; 21:322-328. [PMID: 29271730 DOI: 10.3171/2017.8.peds17327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Current approaches for resection of petrous bone cholesteatomas (PBCs), such as canal wall up (closed) and canal wall down (open) mastoidectomies, in the pediatric population present recurrence rates ranging between 17% and 70% with a high rate of postoperative complications involving hearing loss and facial nerve weakness. This technical note illustrates an alternative intracranial approach that was used in combination with the techniques of piezoelectric surgery, neuroendoscopy, and neuronavigation for safe and effective removal in a difficult pediatric case of recurrent PBC. The third recurrence of a PBC in a 14-year-old girl was diagnosed by CT and MRI. A retrosigmoid approach gave access to the petrous apex, allowing for the safe and complete removal of the lesion and decompression of the facial nerve and internal carotid artery. The intraoperative implementation of piezoelectric surgery, neuronavigation, neuroendoscopy, and neuromonitoring ensured better intraoperative visualization, safer bone removal, and preservation of nerve function, facilitating a macroscopically total resection of the pathology without additional neurological damage of the adjacent tissues. Cholesteatoma extension could be clearly verified by intraoperative neuronavigation. Neuroendoscopy and piezoelectric surgery provided good support in the safe bone removal in close vicinity to neurovascular structures and in full vision inside the cholesteatoma cavity beyond the line of sight of the microscope. Hearing and facial nerve function could be preserved. The presented intracranial retrosigmoid approach combined with multiple intraoperative assisting techniques proved to be effective for the safe and complete removal of recurrent PBC, providing excellent intraoperative visualization and the possibility of preserving cranial nerve function.
Collapse
Affiliation(s)
| | | | | | - Tanja Grauvogel
- 2Otorhinolaryngology-Head and Neck Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg; and
| | - Jan Kaminsky
- 3Department of Neurosurgery, St. Gertrauden Hospital, Berlin, Germany
| | | |
Collapse
|
28
|
Intraoperative Bleeding and the Risk of Residual Cholesteatoma: A Multivariate Analysis. Otol Neurotol 2017; 38:529-534. [DOI: 10.1097/mao.0000000000001355] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Cholesteatoma behind an intact tympanic membrane in adult life: congenital or acquired? The Journal of Laryngology & Otology 2017; 123:488-91. [DOI: 10.1017/s0022215109004496] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Congenital cholesteatoma occurring behind the tympanic membrane is typically located in the anterior middle ear.Objective:To investigate the location, clinical features and treatment of cholesteatomas located behind an intact tympanic membrane in adults.Methods:Review of a series of 265 consecutive, new, adult cases of previously untreated cholesteatoma seen by the author over a 22-year period.Results:Seventeen (6 per cent) cases were located behind an intact tympanic membrane without any evidence of a retraction pocket of the attic or pars tensa. Ten (59 per cent) of these patients had undergone previous ear surgery and therefore the disease could reasonably be considered to be iatrogenic. The most common presentation was conductive deafness with no other symptoms (71 per cent). In all of the cases, the disease was located in the posterior half of the middle-ear space. The most common surgical management was simple excision of the disease via a tympanotomy. Two cases (12 per cent) developed residual disease.Conclusion:The majority of the cases in this series were likely to be acquired cholesteatomas. This type of disease often presents with conductive hearing loss alone.
Collapse
|
30
|
Hatano M, Ito M, Sugimoto H, Noda M, Hasegawa H, Yoshizaki T. Soft-wall reconstruction of the canal wall with retrograde bone work for pediatric cholesteatoma: Long-term results. Int J Pediatr Otorhinolaryngol 2016; 91:159-165. [PMID: 27863632 DOI: 10.1016/j.ijporl.2016.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/22/2016] [Accepted: 10/24/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To retrospectively evaluate the long-term results of surgery for retrograde bone work, using soft-wall reconstruction of the canal wall, for pediatric cholesteatoma. METHODS We retrospectively evaluated a series of 25 consecutive ears of 24 patients who were ≤16 years of age. All children underwent cholesteatoma surgery between October 2002 and August 2008. The type of cholesteatoma, the length of follow-up, the incidence of residual and recurrent cholesteatoma, postoperative hearing results, and the form of the reconstructed external canal wall and tympanic membrane were assessed. RESULTS There were 21 males and 3 females. The procedure was performed on both ears of one patient who had bilateral congenital cholesteatoma (CC). At the initial surgery, 16 cases (64%) had CC and nine (36%) had acquired cholesteatoma (AC). The mean age at surgery was 8.2 years and 10.4 years for CC and AC cases, respectively. The mean postoperative follow-up period after the initial surgery was 90 months for CC cases and 108 months for AC cases. Cholesteatoma recurrence occurred for 6% and 56% of cases with CC and AC, respectively. Successful serviceable hearing was achieved for 93.8% with CC and 100% with AC. Cases with inadequate hearing after surgery were characterized by disease extension to the mastoid and the protympanum. The long-term forms of the reconstructed external canal wall changed depending on their middle ear aeration. Some cases of tympanic membrane perforation and otitis media with effusion were occurred during the follow-up period. CONCLUSION Overall, the retrograde approach with soft-wall reconstruction of the canal wall achieved a low recurrence rate for cholesteatoma and good hearing outcomes during long-term follow-up for the pediatric case. However, in cases with eustachian tube dysfunction and/or cholesteatoma involving the protympanum, the hearing outcomes were less favorable.
Collapse
Affiliation(s)
- Miyako Hatano
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan.
| | - Makoto Ito
- Department of Pediatric Otolaryngology, Jichi Medical University, Tochigi Pediatric Medical Center, Tochigi, Japan
| | - Hisashi Sugimoto
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Masao Noda
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroki Hasegawa
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tomokazu Yoshizaki
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| |
Collapse
|
31
|
Cho HS, Kim HG, Jung DJ, Jang JH, Lee SH, Lee KY. Clinical Aspects and Surgical Outcomes of Congenital Cholesteatoma in 93 Children: Increasing Trends of Congenital Cholesteatoma from 1997 through 2012. J Audiol Otol 2016; 20:168-173. [PMID: 27942603 PMCID: PMC5144821 DOI: 10.7874/jao.2016.20.3.168] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/27/2016] [Accepted: 07/18/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The recent increase in the reported incidence of congenital cholesteatoma (CC) may be secondary to the widespread use of otoendoscopy as well as an increased awareness of these lesions among primary care physicians. However, little research about CC has been conducted in a large group of patients. This study aimed to analyze the clinical characteristics of CC including the annual number of patients, symptoms, age at diagnosis, stage and type of disease, surgical techniques, recurrence, and postoperative complications. SUBJECTS AND METHODS Retrospective chart review was performed for patients who met the inclusion criteria between January 1997 and June 2012. RESULTS Ninety-three patients underwent surgery for CC. The age at operation ranged from 12 months to 17 years (mean age, 6.1 years). The number of patients was less than 4 per year until 2005, but increased to more than 10 per year since 2008. CC was most commonly reported as an incidental finding (58.1%). The operative procedures included the transcanal myringotomy approach (46.2%), canal wall up mastoidectomy (37.6%), tympanoplasty (8.6%), and canal wall down mastoidectomy (7.5%). The recurrence rate was 20.4% and the complication rate was 12.9%. No patients with stage I CC had complications. CONCLUSIONS This study showed that the incidence of CC has recently increased notably. Most patients with stage I and II CC were completely cured by transtympanic surgery, and complication and recurrence rates increased according to the extent of disease. Early detection of CC is important to facilitate minimally invasive surgery and to reduce complication and recurrence rates.
Collapse
Affiliation(s)
- Hyun Soo Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hak Geon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Da Jung Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeong Hun Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Heun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Daegu Veterans Hospital, Daegu, Korea
| | - Kyu-Yup Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
32
|
|
33
|
Cohen MS, Landegger LD, Kozin ED, Lee DJ. Pediatric endoscopic ear surgery in clinical practice: Lessons learned and early outcomes. Laryngoscope 2015; 126:732-8. [DOI: 10.1002/lary.25410] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 05/06/2015] [Accepted: 05/08/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Michael S. Cohen
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Lukas D. Landegger
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Elliott D. Kozin
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Daniel J. Lee
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| |
Collapse
|
34
|
Pediatric middle ear cholesteatoma: the comparative study of congenital cholesteatoma and acquired cholesteatoma. Eur Arch Otorhinolaryngol 2015; 273:1155-60. [DOI: 10.1007/s00405-015-3679-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
|
35
|
Opacification of the middle ear and mastoid: imaging findings and clues to differential diagnosis. Clin Radiol 2015; 70:e1-e13. [DOI: 10.1016/j.crad.2014.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/19/2014] [Accepted: 11/26/2014] [Indexed: 11/17/2022]
|
36
|
Updates and knowledge gaps in cholesteatoma research. BIOMED RESEARCH INTERNATIONAL 2015; 2015:854024. [PMID: 25866816 PMCID: PMC4381684 DOI: 10.1155/2015/854024] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 12/15/2022]
Abstract
The existence of acquired cholesteatoma has been recognized for more than three centuries; however, the nature of the disorder has yet to be determined. Without timely detection and intervention, cholesteatomas can become dangerously large and invade intratemporal structures, resulting in numerous intra- and extracranial complications. Due to its aggressive growth, invasive nature, and the potentially fatal consequences of intracranial complications, acquired cholesteatoma remains a cause of morbidity and death for those who lack access to advanced medical care. Currently, no viable nonsurgical therapies are available. Developing an effective management strategy for this disorder will require a comprehensive understanding of past progress and recent advances. This paper presents a brief review of background issues related to acquired middle ear cholesteatoma and deals with practical considerations regarding the history and etymology of the disorder. We also consider issues related to the classification, epidemiology, histopathology, clinical presentation, and complications of acquired cholesteatoma and examine current diagnosis and management strategies in detail.
Collapse
|
37
|
Abstract
Cholesteatomas can be subclassified into genuine and acquired forms. Whilst epidermoid formations are the generally accepted cause of genuine cholesteatomas, metaplasia, immigration, proliferation and retraction pocket theories have all been proposed to explain the development of acquired cholesteatomas. Clinically, paediatric cholesteatomas exhibit more extensive and aggressive growth than those arising in adulthood. Molecular biological differences in terms of angiogenesis, cytokine expression and particularly the more marked inflammatory responses of the perimatrix could potentially explain these clinical differences. The surgical therapy of paediatric cholesteatomas should be adapted to the individual pathological findings, although where possible a canal wall up procedure is preferred during initial surgery. The "inside-out" mastoidectomy tracking-technique combines the benefits of a good surgical overview with those of a physiological postoperative auditory canal.
Collapse
|
38
|
Sugimoto H, Ito M, Yoshizaki T. Retrograde approach and soft wall reconstruction in surgery for congenital cholesteatoma. Acta Otolaryngol 2013; 133:1142-7. [PMID: 24125185 DOI: 10.3109/00016489.2013.817683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS A retrograde approach and soft wall reconstruction is thought to be an effective surgical approach for patients with good eustachian tube function and good mastoid development such as in congenital cholesteatoma. OBJECTIVE To analyze the usefulness of a retrograde approach and soft wall reconstructive surgical treatment for congenital cholesteatoma. METHODS Data from 24 patients (25 ears in total) who underwent surgical intervention for congenital cholesteatoma at Kanazawa University Hospital between January 2001 and July 2011 were retrospectively reviewed. We had used a retrograde approach for congenital cholesteatomas in which bone is removed as necessary in a retrograde manner from the external auditory canal side. The extent of bone removal was determined according to the location of the cholesteatoma. The posterior walls of the external auditory canals were reconstructed with soft tissue using temporal fascia. RESULTS Good preoperative mastoid development was identified in 83% of the patients. Postoperative recurrence was seen in 1 of 25 ears. Analysis of pre- and postoperative hearing ability showed significant improvement in both pure tone audiogram air conduction and pure tone audiogram air-bone gaps.
Collapse
Affiliation(s)
- Hisashi Sugimoto
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
| | | | | |
Collapse
|
39
|
Abstract
AbstractIntroduction:The exact aetiology of congenital cholesteatoma, the less common form of this destructive disease, is still under debate.Case report:A two-year-old boy was referred to paediatric otolaryngology with persistent, bloody, left-sided otorrhoea refractory to oral and ototopical antibiotics. Prior to its onset at age 16 months, all ear examinations on the affected side were normal. Physical examination, imaging with computed tomography and eventual tympanomastoidectomy revealed extensive cholesteatoma. The extent of the disease, age at onset of symptoms and absence of otological disease before initial presentation suggested the diagnosis of congenital cholesteatoma. Review of the family history revealed that the patient's older brother had undergone tympanomastoidectomy for a small, well-encapsulated, mesotympanic congenital cholesteatoma at two years of age.Discussion:This case joins a single, previous report describing congenital cholesteatoma in multiple family members, suggesting that in some cases, hereditary factors may play a role in the formation of the disease.
Collapse
|
40
|
Lee SH, Jang JH, Lee D, Lee HR, Lee KY. Surgical outcomes of early congenital cholesteatoma: Minimally invasive transcanal approach. Laryngoscope 2013; 124:755-9. [DOI: 10.1002/lary.24313] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/20/2013] [Accepted: 06/20/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Sang H. Lee
- Department of Otorhinolaryngology-Head & Neck Surgery; School of Medicine, Kyungpook National University; Daegu Korea
- Department of Otorhinolaryngology-Head & Neck Surgery; Daegu Veterans Hospital; Daegu Korea
| | - Jeong H. Jang
- Department of Otorhinolaryngology-Head & Neck Surgery; School of Medicine, Kyungpook National University; Daegu Korea
| | - Dongjun Lee
- Department of Otorhinolaryngology-Head & Neck Surgery; School of Medicine, Kyungpook National University; Daegu Korea
| | - Hye-Ryung Lee
- Department of Otorhinolaryngology-Head & Neck Surgery; Daegu Veterans Hospital; Daegu Korea
| | - Kyu-Yup Lee
- Department of Otorhinolaryngology-Head & Neck Surgery; School of Medicine, Kyungpook National University; Daegu Korea
| |
Collapse
|
41
|
Yamatodani T, Mizuta K, Hosokawa K, Takizawa Y, Sugiyama K, Nakanishi H, Mineta H. Congenital middle ear cholesteatoma: experience from 26 surgical cases. Ann Otol Rhinol Laryngol 2013; 122:316-21. [PMID: 23815048 DOI: 10.1177/000348941312200505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We analyzed the clinical features and surgical techniques used in cases of childhood congenital cholesteatoma of the middle ear. METHODS We studied 26 patients (26 ears) who underwent surgery for congenital cholesteatoma between January 1998 and December 2009, focusing on the location and type of cholesteatoma, the surgical procedures involved, and the results obtained. Patients with prior otologic procedures were excluded. A 4-stage system was used to grade the cholesteatomas. RESULTS The frequency of posterior-quadrant involvement and open-type cholesteatomas increased in the more advanced stages. Second-look operations were performed in 60% of stage III and 75% of stage IV cases; and residual cholesteatomas were found in 20% of stage III and 75% of stage IV cases. Of the cases evaluated both before and after the operation, 100% of stage I and II cases, 86% of stage III cases, and 50% of stage IV cases showed improvement in hearing function. CONCLUSIONS The staging system is relatively simple, while accurately reflecting clinical results. However, there are many differences between the anterior and posterior types of congenital cholesteatomas in surgical approach and postoperative progression that are not reflected in the classification systems and require further study. In addition, we reviewed the surgical procedures involved in anterior-quadrant cases, and propose a modified surgical procedure.
Collapse
Affiliation(s)
- Takashi Yamatodani
- Department of Otorhinolaryngology-Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | | | | | | | | | | |
Collapse
|
42
|
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
|
43
|
Hafsa C, Jerbi-Omezzine S, Lahmar I, Driss N, Hamza HA. Cholestéatome congéntial. Arch Pediatr 2011; 18:1185-7. [DOI: 10.1016/j.arcped.2011.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 06/15/2010] [Accepted: 08/08/2011] [Indexed: 11/16/2022]
|
44
|
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
|
45
|
Skotnicka B, Hassmann-Poznańska E. [Clinical and pathological features of cholesteatoma in young children]. Otolaryngol Pol 2011; 64:375-81. [PMID: 21302505 DOI: 10.1016/s0030-6657(10)70590-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Children cholesteatoma have been shown to demonstrate aggressive growth with greater extension and higher rates residual and recurrent disease compared with adults, due to anatomic and physiologic differences. AIM This study aimed to determine the clinical and pathological features of cholesteatoma in young children less than 7 years of age. MATERIAL AND METHODS Retrospective review of a group of 23 children (24 ears) who had cholesteatoma surgery between 1996 and 2004. Patients ages ranged from 1.8 to 7 years, follow up from 3.5 to 12 years (mean 7.4). Medical history (previous otorrhea, hearing loss) and contralateral ear status was analyzed. The extent of cholesteatoma and ossicular destruction for attic, pars tensa I and pars tensa II type and congenital of cholesteatoma was graded using of Saleh and Mills classification. Residual and recurrent disease depending on type of cholesteatoma, extent of the disease, type of surgery and contalateral ear status was assessed. RESULTS Otorrhea and hearing loos are the most common clinical symptoms observed in 90% and 59% children. 70% of treated children had otitis media with effusion and/or its sequel in contralateral ear. 60% of acquired cholesteatomas were classified as S3 and S4 extension during surgery with ossicular destruction in 46% of attic cholestatoma. 75% operated ears had a signs of mucosa inflammation during surgery. Residual cholesteatoma was observed in 38.5% ears with attic cholesteatoma and in 25% with pars tensa I cholesteatoma. CONCLUSION Acquired cholesteatoma in young children are diagnosed in the advanced stages with ossicular chain destruction. High rate of recidivism after surgery, particularly in attic cholesteatomas is observed. Most of operated ears have symptoms of inflammation of middle era mucosa during surgery and otitis media with effusion in contralateral ear and because of that need long-term follow up and constant observation.
Collapse
|
46
|
Cohen MA, Kuroiwa MA, Berkowitz RG. Acquired cholesteatoma in children following congenital cholesteatoma surgery. Int J Pediatr Otorhinolaryngol 2011; 75:43-8. [PMID: 21074279 DOI: 10.1016/j.ijporl.2010.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 09/23/2010] [Accepted: 10/01/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine the incidence of severe atelectatic otitis media and acquired cholesteatoma (AC) in children treated for congenital cholesteatoma (CC). METHODS Retrospective chart review of 15 children who underwent primary surgery for CC over a 15 year period by a single surgeon. RESULTS The mean postoperative follow up was 3.1 years. Significant tympanic retraction occurred in 6 children, included a retraction pocket that required T-tube insertion (3), and AC requiring tympanomastoid surgery (3). There was no complication related to retraction pocket in 9 children however 2 developed residual disease. In comparing the two groups, those with and without subsequent significant tympanic retraction, both groups had similar gender, age, extent of CC (median Potsic grade of 2), bone erosion, and surgical technique. Differences were noted in air-bone gap at presentation (PTA 32.4 and 17.25), otitis media with effusion in the contralateral ear (3/6 and 1/9), smaller mastoid volume ratio compared with the contralateral ear (0.74 and 1.21), and longer average timing for second surgery (14.8 months and 8 months). CONCLUSIONS Acquired middle ear disease, including cholesteatoma, can follow surgical removal of CC, and long term follow up of all patients is required. Factors at initial evaluation indicative of risk of AC include a significant air-bone gap, otitis media with effusion in the contralateral ear and a smaller mastoid cavity ratio. The use of composite grafts at the time of CC surgery should be considered. Additionally, our findings suggest that the mastoid volume plays a causative role in the development of AC.
Collapse
Affiliation(s)
- Mauricio A Cohen
- Department of Otolaryngology, Faculty of Medicine, University of Chile, Santiago, Chile.
| | | | | |
Collapse
|
47
|
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
|
48
|
Contemporary assessment and management of congenital cholesteatoma. Curr Opin Otolaryngol Head Neck Surg 2009; 17:339-45. [PMID: 19745736 DOI: 10.1097/moo.0b013e3283303688] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Only 2-4% of cholesteatomas presenting to pediatric otologists are congenital in origin. Disease severity can range from intratympanic pearls to middle ear and mastoid obliteration. Recently, highlighted variations of this rare disorder warrant a systematic approach to disease assessment and surgical decision making. This review provides a comprehensive method to diagnose and manage congenital cholesteatoma based on current literature. RECENT FINDINGS The holding theory of the origin of congenital cholesteatomas is that they arise from retained epithelial cell rest. Primary development can vary among sites within the middle ear and mastoid. 'Open' and 'closed' varieties have been proposed. However, disease severity depends on location, patient age, ossicular integrity, and number of anatomic sites involved. These variables have inspired the development of staging systems whereby appropriate surgical approaches can be designed. Computed tomography (CT) scans are necessary and continue to be the best radiographic tool for surgical planning. Over 30% of congenital cholesteatomas can be extirpated through a transcanal approach. Involvement of the posterior quadrant, over three anatomic subsites, or the mastoid cavity obligates standard canal wall-up techniques. Canal wall-down procedures are rarely required. SUMMARY Congenital cholesteatomas frequently extend beyond the typically described anterosuperior location of the middle ear. Ossicular destruction, mastoid infiltration, and tympanic membrane rupture are encountered more frequently than previously thought. Advanced disease predominately occurs in older children and requires sophisticated assessment and surgical planning beyond removing a simple keratin cyst.
Collapse
|
49
|
In reference to Cochleovestibular Anomalies in Children With Cholesteatoma. Laryngoscope 2008; 118:1905-6. [DOI: 10.1097/mlg.0b013e31817dd045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
50
|
Mornet E, Martins-Carvalho C, Valette G, Potard G, Marianowski R. [Adult localized congenital cholesteatoma]. ANNALES D'OTO-LARYNGOLOGIE ET DE CHIRURGIE CERVICO FACIALE : BULLETIN DE LA SOCIETE D'OTO-LARYNGOLOGIE DES HOPITAUX DE PARIS 2008; 125:85-89. [PMID: 18281009 DOI: 10.1016/j.aorl.2007.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Accepted: 10/10/2007] [Indexed: 05/25/2023]
Abstract
PURPOSE OF THE STUDY Congenital cholesteatoma is a well-described anatomical and clinical entity. Adult forms are rare. We describe a posterosuperior encapsulated cholesteatoma and compare this case to other infantile and adult forms described in the literature. MATERIAL AND METHODS A 25-year-old patient with no medical history consulted for left conductive hearing loss. A flat tympanogram was obtained. The temporal bone computed tomographic scan showed a soft tissue density lesion of the middle ear and anterior stapes erosion. A congenital cholesteatoma was discovered during surgical exploration. The lesion was removed and the ossicular chain was reconstructed with a Shea piston. RESULTS The patient showed approximately 20dB conductive hearing improvement. DISCUSSION Existence of congenital cholesteatoma is well established. Adult forms are exceptional and often diffuse. A localized, encapsulated form is described in this article. The specificity remains unknown. It is uncertain whether the adult and infantile forms have the same origin. A multifactorial or metaplastic mechanism could explain adult congenital cholesteatoma. CONCLUSION Pathogenic hypothesis for adult forms of congenital cholesteatoma are different from infantile forms.
Collapse
Affiliation(s)
- E Mornet
- Service d'ORL, hôpital Morvan, 29200 Brest, France
| | | | | | | | | |
Collapse
|