The Significance of Staging in the Treatment of Congenital Cholesteatoma in Children

Abstract

Objectives: To analyze the clinical characteristics of congenital cholesteatoma (CC), to explore the risk factors related to recurrence of the disease, and to clarify the importance of staging for treatment. Methods: A total of 87 patients were followed up for more than 5 years, who had undergone surgical procedures for CC from September 2010 to January 2017 in Beijing Children’s Hospital, Capital Medical University. Patients with CC were identified in accordance with the following Levenson’s criteria. The clinical characteristics of CC on different stage and risk factors related to recurrence of the disease were analyzed. Results: Canal wall up mastoidectomy and tympanoplasty (n = 45), transcanal endoscopic approach (n = 29), and canal wall down mastoidectomy and tympanoplasty (n = 13) was, respectively, performed depending on cholesteatoma extension. Between 2010 and 2013, 20.93% of patients had stage I-II disease, whereas 61.26% had stage I-II disease from 2014 to 2017. Meanwhile, the proportion with stage III-IV disease decreased from 79.07% to 38.64% between these 2 time periods. The preoperative air conduction threshold in patients with stage I, II, III, and IV was, respectively, 23.36 ± 8.20, 45.40 ± 12.82, 47.49 ± 12.03, and 50.37 ± 11.80 dB. The stage of disease was a significant risk factor regarding recurrence ( P = .02). Surgery on patients with stage III-IV disease was performed with the aid of a microscope from 2010 to 2013 and with a microscope and endoscope from 2014 to 2017, which reduced the recurrence rate from 26.92% in the former period to 8.33% in the latter period. Conclusion: Early detection of CC is crucial regarding the facilitation of minimally invasive surgery and reducing complication and recurrence rates. The stage of the disease is a significant risk factor regarding recurrence. The surgery shows us the possibility of reducing the recurrence rate of CC, which is performed under a microscope and an endoscope.

Transcanal endoscopic treatment for congenital middle ear cholesteatoma in children

“…The mean age of the included patients was 7.91 ± 3.11 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) years. There were 8 and 3 cases of the left and right ear, respectively.…”

“…Therefore, early CMEC detection and treatment are crucial for avoiding the occurrence of serious complications Currently, surgical treatment remains the only treatment for CMEC. [9] Its main objectives are to completely remove lesions, prevent recurrence, and preserve or rebuild hearing. For patients with CMEC, the classical surgical methods include modified radical mastoidectomy and tympanoplasty based on the lesion scope.…”

Transcanal endoscopic treatment for congenital middle ear cholesteatoma in children

“…It is reported that the recurrence rate of CMEC in children is 10.5%-45% [11,12]. At present most reports on CMEC are small-sample reports [7,11,[13][14][15][16], so there is no data to prove that otoendoscope can reduce the recurrence rate of CMEC.…”

Congenital cholesteatoma of the middle ear in children as a rare anomaly with an insidious course – etiopathogenesis, classification and the importance of screening tests in children. Review of the literature

“…Istotną rolę odgrywa wczesna diagnostyka perlaka, ponieważ wczesne wykrycie perlaka umożliwia wykonanie małoinwazyjnego zabiegu, co wpływa na zmniejszenie częstości powikłań i nawrotów [22,23]. Z kolei odpowiednio wczesne usunięcie zmian pozwala w większości przypadków na zachowanie prawidłowego słuchu i uniknięcie niebezpiecznych powikłań.…”

“…W celu ułatwienia wykrycia i podjęcia odpowiednio wcześnie interwencji programy wczesnych badań przesiewowych mogą zalecać badania przesiewowe słuchu i tomografię komputerową. Wielu naukowców podkreśla także istotność rutynowego badania otoskopowego u lekarza POZ [34].…”