Mastoid and Epitympanic Bony Obliteration in Pediatric Cholesteatoma

Vercruysse, Jean‐Philippe; Foer, Bert De; Somers, Thomas; Casselman, Jan; Offeciers, Erwin

doi:10.1097/mao.0b013e318184f4d6

Cited by 70 publications

(31 citation statements)

References 23 publications

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“…An infection following a long period of dry ear status after mastoid obliteration should therefore be considered a new and distinct episode of infection, instead of an obliteration-associated complication. Second, for children with cholesteatomas, it is recidivism that arouses the concern of otologists in terms of the longterm safety of mastoid obliteration [Vercruysse et al, 2008]. We also suggest that long-term, rather than shortterm, observations on recidivism are of primary importance because the postoperative course may be influenced by various unfavorable factors that make the long-term safety unpredictable.…”

Section: Discussionmentioning

confidence: 99%

“…However, the mean follow-up period was only 3.1 years, and the potential for a later discovery of a residual cholesteatoma cannot be ruled out. Vercruysse et al [2008] emphasized that all surgical results must be considered preliminary until the full 5-year follow-up results become available to determine any possible long-term safety concerns. Only a few studies have reported such 'long-term' results (5 years or longer) for pediatric cholesteatomas [Roger et al, 1997;Roth and Haeusler, 2009;Stangerup et al, 2000].…”

Section: Discussionmentioning

confidence: 99%

“…In cholesteatoma surgery, the canal wall down (CWD) technique achieves a relatively low recurrence rate compared with that achieved using the canal wall up (CWU) technique [Vercruysse et al, 2008]. However, the CWD technique results in the exenteration of the mastoid air cells and, subsequently, an open cavity.…”

Section: Introductionmentioning

confidence: 99%

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Mastoid Obliteration for Pediatric Suppurative Cholesteatoma: Long-Term Safety and Sustained Effectiveness after 30 Years' Experience with Cartilage Obliteration

Kuo

Lien²,

Shiao³

2014

Audiol Neurotol

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Objective: To analyze the long-term safety of mastoid obliteration with cartilage in children with suppurative cholesteatomatous ears. Methods: The medical records of children (≤18 years) with cholesteatomas after primary tympanomastoidectomies were performed with cartilage obliteration over a 30-year period (1982-2012) were analyzed. The recidivism rate was calculated using the Kaplan-Meier survival analysis. Potentially confounding factors of recidivism were entered into a Cox regression model as covariates for multivariate analysis. Results: Of the 150 cholesteatomatous ears in 146 children, there were 95 discharging ears (63%) in 94 children. Among the 95 discharging ears, tympanomastoidectomy was performed with cartilage obliteration (CO group) in 77 ears (81%) and without cartilage obliteration (WO group) in 18 ears (19%). The mean follow-up period was 12 years. Recidivism was observed in 16 ears in the CO group and 4 ears in the WO group. The 10-year cumulative recidivism rates were comparable between the CO and WO groups (19 vs. 25%, p = 0.762). Multivariate analysis confirmed that mastoid obliteration was not a negative predictor of recidivism (p = 0.760). Recidivism of cholesteatoma was detected within 6.5 years after surgery in the WO group and was found as late as 16.1 years after surgery in the CO group. Cartilage could be maintained in the cavity with limited resorption, preventing reretraction pockets and subsequent recidivism. Conclusion: This study provides evidence supporting the long-term safety, feasibility and effectiveness of mastoid cartilage obliteration for children with suppurative cholesteatomatous ears. Despite comparable recidivism rates between the groups, the potential for the delayed detection of recidivism with cavity obliteration may warrant long-term follow-up, with careful attention paid to the potential for recidivism during postoperative care in children. i 2014 S. Karger AG, Basel

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Mastoid Obliteration for Pediatric Suppurative Cholesteatoma: Long-Term Safety and Sustained Effectiveness after 30 Years' Experience with Cartilage Obliteration

Kuo

Lien²,

Shiao³

2014

Audiol Neurotol

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“…3). В настоящее время МРТ является достоверным методом для контроля резидуального заболевания и диа-гностики рецидива [16,17]. Специфичность метода в диагностике холестеатомы по данным разных авторов составляет от 86 до 100% [18,19].…”

Section: результаты и обсуждениеunclassified

The modern approaches to the treatment of chronic suppurative otitis with cholesteatoma

Kosiakov¹,

Pchelenok²

2014

Vestn. otorinolaringol.

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Хронический гнойный средний отит -серьезное за-болевание, остающееся важной проблемой социального и экономического характера во всем мире. Распространен-ность ХГСО в нашей стране составляет от 8,4 до 39,2% на 1000 населения. При этом ХГСО с холестеатомой, по дан-ным разных авторов, составляет от 24 до 63% случаев [1].Холестеатома сопровождается прогрессивным ростом и деструкцией подлежащих костных структур среднего уха. Последние исследования в области молекулярной биологии показали, как воздействует периматрикс холе-стеатомы на костную ткань, приводя к ее резорбции [2,3]. В этом процессе основным фактором воздействия на костный матрикс являются остеокласты и деградация экс-трацеллюлярного матрикса [4,5]. Лечение холестеатомы -только хирургическое. Особой проблемой, снижающей эффективность хирургического лечения, являются реци-дивирование холестеатомы и резидуальное заболевание.В настоящее время существуют два основных метода хирургии холестеатомы: закрытая техника (wall up) с со-хранением задней стенки наружного слухового прохода и

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“…Recent reports indicate that obliteration of mastoid air spaces is associated with low rates of recurrent cholesteatoma [10] , indeed lower than may be expected from CWU surgery without obliteration. For example, recurrent cholesteatoma rates of around 2% at five-year follow-up have been reported with mastoid obliteration after canal wall down (CWD) surgery in both pediatric and adult patients [11][12][13] and also when obliterating the mastoid as part of CWU surgery [14,15] . Mathematical modeling has led to the hypothesis that obliteration is so effective because removal of gas exchange surfaces in ears with small tympanomastoid volume stabilizes middle ear pressure [16] .…”

Section: Introductionmentioning

confidence: 99%

Assessment of Mastoid Function with Magnetic Resonance Imaging after Canal Wall Up Cholesteatoma Surgery

Parkes

Cushing²,

Papsin³

et al. 2016

Int Adv Otol

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OBJECTIVE:To use magnetic resonance imaging (MRI) to assess the extent of mastoid opacification after canal wall up (CWU) cholesteatoma surgery. MATERIALS and METHODS:Thirty-five children in whom post-operative MRI had been obtained after CWU surgery. Cholesteatoma confined to the meso-and/or epi-tympanum was removed using a transcanal approach (n=18). More extensive disease required a combined approach tympanomastoidectomy (CAT, n=17). Mastoid opacification was assessed in both ears by a neuroradiologist blind to surgical details using an ordinal scale from 0 (no opacification) to 6 (completely opacified). The primary outcome measure was presence of normal mastoid ventilation, defined by evaluation of non-operative ears as a score ≤2. The presence of normal ventilation, as well as the raw opacification scores, were compared according to type of cholesteatoma surgery: 1) transcanal, with no mastoidectomy and 2) CAT. RESULTS:Mastoid ventilation was normal in 18 post-operative ears (51%). There was no significant difference in the proportion of normally ventilated mastoids in the CAT (n=17) and transcanal (n=18) groups (p=0.318; Fisher's exact). However, mastoid opacification scores were significantly higher in the CAT group than in the transcanal group (p=0.036; Mann-Whitney U). CONCLUSION:The mastoid frequently fails to become normally ventilated after cholesteatoma surgery. Subgroup analysis suggests cortical mastoidectomy does not increase the likelihood of normal mastoid ventilation after CWU cholesteatoma surgery. MRI provides a non-invasive tool to assess mastoid function, which contributes to the current debate on optimum surgical strategies for management of the mastoid in cholesteatoma surgery. Further research will determine whether this measure of mastoid health correlates with risk of recurrent cholesteatoma.

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Mastoid and Epitympanic Bony Obliteration in Pediatric Cholesteatoma

Abstract: The mastoid and epitympanic BOT is an effective technique to lower the recurrence rate of cholesteatoma in the pediatric population. Follow-up by magnetic resonance imaging provides a safe, noninvasive method for postoperative detection of residual cholesteatoma.

Cited by 70 publications

References 23 publications

Mastoid Obliteration for Pediatric Suppurative Cholesteatoma: Long-Term Safety and Sustained Effectiveness after 30 Years' Experience with Cartilage Obliteration

Mastoid Obliteration for Pediatric Suppurative Cholesteatoma: Long-Term Safety and Sustained Effectiveness after 30 Years' Experience with Cartilage Obliteration

The modern approaches to the treatment of chronic suppurative otitis with cholesteatoma

Assessment of Mastoid Function with Magnetic Resonance Imaging after Canal Wall Up Cholesteatoma Surgery

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