Surgical Treatment of Pediatric Cholesteatomas

Shirazi, Mobeen A.; Muzaffar, Kamil; Leonetti, John; Marzo, Sam J.

doi:10.1097/01.mlg.0000233248.03276.9b

Cited by 76 publications

(42 citation statements)

References 11 publications

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“…Unlike other studies, our patient was much younger than what has been previously reported where the mean age vary from 37 to 56 years [6][7][8][9]. Cholesteatomas in children have a more aggressive growth pattern relative to adults [12][13][14]. The incidence of both residual and recurrent disease is higher in this population and remains a cause of pediatric morbidity and occasionally death in developing country [12,15].…”

Section: Discussioncontrasting

confidence: 72%

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Canal wall window mastoidectomy for extensive labyrinthine cholesteatoma: Total dissection and hearing preservation

Bergeron

Saliba

2011

International Journal of Pediatric Otorhinolaryngology

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Section: Discussioncontrasting

confidence: 72%

“…Cholesteatomas in children have a more aggressive growth pattern relative to adults [12][13][14]. The incidence of both residual and recurrent disease is higher in this population and remains a cause of pediatric morbidity and occasionally death in developing country [12,15].…”

Section: Discussionmentioning

confidence: 98%

Canal wall window mastoidectomy for extensive labyrinthine cholesteatoma: Total dissection and hearing preservation

Bergeron

Saliba

2011

International Journal of Pediatric Otorhinolaryngology

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“…Surgery in the form of tympanomastoidectomy is also indicated in cases of CSOM in which there are complications, some of which could potentially be life threatening, such as significant hearing loss, facial nerve palsy, subperiosteal abscess, petrositis, dural venous sinus thrombosis, meningitis, cerebral abscess and labyrinthine fistula, among others (Kangsanarak et & Berkowitz, 2004;Matanda et al, 2005;Zanetti & Nassif, 2006;Dubey & Larawin, 2007;Akinpelu et al, 2008;Mostafa et al, 2009). Chronic cholesteatomatous OM requires surgery, usually in the form of tympanomastoidectomy in order to eradicate cholesteatoma, a usual underlying cause of chronic infection (Shirazi et al, 2006). However, some retrospective studies show that there is no difference in outcomes of graft success rate or post-operative hearing with regard to whether mastoidectomy is performed in addition to tympanoplasty (Balyan et al, 1997;Mishiro et al, 2001).…”

Section: Surgerymentioning

confidence: 99%

Current concepts in the pathogenesis and treatment of chronic suppurative otitis media

Mittal

Lisi

Gerring

et al. 2015

Journal of Medical Microbiology

200

161

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Otitis media (OM) is an inflammation of the middle ear associated with infection. Despite appropriate therapy, acute OM (AOM) can progress to chronic suppurative OM (CSOM) associated with ear drum perforation and purulent discharge. The effusion prevents the middle ear ossicles from properly relaying sound vibrations from the ear drum to the oval window of the inner ear, causing conductive hearing loss. In addition, the inflammatory mediators generated during CSOM can penetrate into the inner ear through the round window. This can cause the loss of hair cells in the cochlea, leading to sensorineural hearing loss. Pseudomonas aeruginosa and Staphylococcus aureus are the most predominant pathogens that cause CSOM. Although the pathogenesis of AOM is well studied, very limited research is available in relation to CSOM. With the emergence of antibiotic resistance as well as the ototoxicity of antibiotics and the potential risks of surgery, there is an urgent need to develop effective therapeutic strategies against CSOM. This warrants understanding the role of host immunity in CSOM and how the bacteria evade these potent immune responses. Understanding the molecular mechanisms leading to CSOM will help in designing novel treatment modalities against the disease and hence preventing the hearing loss. IntroductionOtitis media (OM) refers to a group of complex infectious and inflammatory diseases affecting the middle ear (Dickson, 2014). OM in general is very common, as studies show that around 80 % of children should have experienced at least one episode by their third birthday (Teele et al., 1989). OM has been broadly classified into two main types, acute and chronic. Acute OM (AOM) is characterized by the rapid onset of signs of inflammation, specifically bulging and possible perforation of the tympanic membrane, fullness and erythema, as well as symptoms associated with inflammation such as otalgia, irritability and fever (Pukander, 1983;Harkness & Topham, 1998). Despite appropriate antibiotic therapy, AOM may progress to chronic suppurative OM (CSOM) characterized by persistent drainage from the middle ear associated with a perforated ear drum (Wintermeyer & Nahata, 1994;Harkness & Topham, 1998). When examined by otoscope, the middle ear looks red and inflamed with purulent discharge in CSOM patients (Figs 1 and 2). It is one of the most common chronic infectious diseases worldwide especially affecting children (Roland, 2002; Verhoeff et al., 2006). Hearing impairment is one of the most common sequelae of CSOM (Aarhus et al., 2015). The resultant hearing loss can have a negative impact on a child's speech development, education and behaviour (Olatoke et al., 2008; Khairi Md Daud et al., 2010). Mortality due to complications of CSOM is typically higher than other types of OM (Yorgancilar et al., 2013a;Qureishi et al., 2014). Intracranial complications like brain abscess and meningitis are the most common causes of death in CSOM patients (Dubey et al., 2010;Chew et al., 2012;Sun & Sun, 2014).In this article, the rec...

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“…These concerns include operating on the only hearing ear, poor follow-up, requirement of a single-stage procedure, sclerotic mastoid, and labyrinthine fistula (11,15).…”

Section: Resultsmentioning

confidence: 99%

Retrograde mastoidectomy on demand with soft-wall reconstruction in pediatric cholesteatoma

Hatano¹,

Ito²,

Yoshizaki³

2010

Acta Oto-Laryngologica

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Objective: To evaluate surgical outcomes of retrograde mastoidectomy when using soft-wall reconstruction in pediatric cholesteatoma.Study Design: Retrospective case review. Setting: Tertiary referral center.Patients: A total of 25 children underwent cholesteatoma removal surgery employing soft-wall reconstruction. Average follow-up time was 48.7 months.Intervention: In order to fully expose and extirpate the disease, the bony canal wall was removed in association with a retrograde-type mastoidectomy in all cases. The posterior ear canal defect was then reconstructed using soft-tissue; i.e., temporal fascia and canal wall skin. Main Outcome Measures:The incidence and localization of residual and recurrent cholesteatoma, preoperative and postoperative audiogram results, pure-tone average, and air-bone gap were assessed. Results:Residual cholesteatoma was detected in 5 (20%) out of 25 ears. There were 4 small residual cholesteatomas that were located in the posterior tympanic sinus, on the stapedial tendon, on the stapes head, and in the epitympanum, respectively. As we found aggressive residual disease in 1 case, the total recurrent cholesteatoma was 1 (4%) out of 25 ears. The mean preoperative pure-tone average (PTA) of air conduction (AC) was 39.1 dB, while the preoperative PTA of the air-bone gaps (ABG) was 28.8 dB. At 6 months or more after the last surgical intervention, the mean postoperative PTA-AC and PTA-ABG were 20.9 dB and 11.7 dB, respectively. The mean hearing gain was 18.1 dB.The differences between the pre-and postoperative values were statistically significant (p < 0.05). Conclusion:Retrograde mastoidectomy with soft-wall reconstruction is an effective technique that can be used to lower the recurrence rate of cholesteatoma in the pediatric population.

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Surgical Treatment of Pediatric Cholesteatomas

Cited by 76 publications

References 11 publications

Canal wall window mastoidectomy for extensive labyrinthine cholesteatoma: Total dissection and hearing preservation

Canal wall window mastoidectomy for extensive labyrinthine cholesteatoma: Total dissection and hearing preservation

Current concepts in the pathogenesis and treatment of chronic suppurative otitis media

Retrograde mastoidectomy on demand with soft-wall reconstruction in pediatric cholesteatoma

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