Comparison of congenital and acquired cholesteatomas in pediatric patients

Year 2018, Volume: 28 Issue: 2, 59 - 65, 15.06.2018

Emine Demir Görkem Atsal Filiz Gülüstan Abdullah Dalgıç Levent Olgun

Abstract

Objectives: This study aims to present clinical data and surgical results of patients with congenital cholesteatoma CC and acquired cholesteatoma AC . Patients and Methods: Pediatric cholesteatoma patients who underwent tympanomastoid surgery between January 2008 and June 2015 were evaluated retrospectively. Demographic data, clinical symptoms, surgical and post-surgical findings were recorded. Mastoid development was evaluated with preoperative temporal bone computed tomography. Areas with cholesteatoma were mapped intraoperatively and cholesteatoma was staged. Intraoperative stapes superstructure deformation was assessed. Postoperative hearing results were compared according to air bone gap ABG values. Statistical analysis was made by MannWhitney U and Kruskal Wallis test. Results: We analyzed 60 patients 9 CC and 51 AC under 16 years of age and followed at least six months. In the CC and AC groups, mean age was 6.1 and 10.4 years, and mean follow-up was 28 and 32 months, respectively. While CC group patients were generally asymptomatic, AC group patients were diagnosed with complaints of otorrhea, otalgia and hearing loss. Mastoid development was better in CC group patients p<0.001 . Intraoperatively, the AC mostly covered two or more regions while CC was mostly in one region. There was more deformity of stapes superstructure in AC group patients p=0.019 . Recurrence rates were similar for CC and AC groups and for different types of surgeries p=0.128 . Functional postoperative hearing ABG ≤10dB was 44.4% in the CC group and 25.4% in the AC group. Conclusion: The AC is more common than the CC, mastoid development is worse and ossicles are affected more. There are no significant differences in recurrence rates of applied surgeries. However, postoperative hearing results are better in patients who external ear canal preservation, which has an advantage of not causing more mastoidectomy cavity problems. With the main condition of completely removing pathology, these techniques can easily be preferred in cholesteatoma surgery.

Keywords

Acquired cholesteatoma, cholesteatoma surgery, congenital cholesteatoma, pediatric cholesteatoma, tympanomastoidectomy

References

• Schraff SA, Strasnick B. Pediatric cholesteatoma: a retrospective review. Int J Pediatr Otorhinolaryngol 2006;70:385-93.
• Morita Y, Yamamoto Y, Oshima S, Takahashi K, Takahashi S. Acquired cholesteatoma in children: clinical features and surgical outcome. Auris Nasus Larynx 2014;41:417-21.
• Morita Y, Yamamoto Y, Oshima S, Takahashi K, Takahashi S. Pediatric middle ear cholesteatoma: the comparative study of congenital cholesteatoma and acquired cholesteatoma. Eur Arch Otorhinolaryngol 2016;273:1155-60.
• Trinidade A, Skingsley A, Yung MW. Pediatric cholesteatoma surgery using a single-staged canal wall down approach: results of a 5-year longitudinal study. Otol Neurotol 2015;36:82-5.
• Yung M, Jacobsen NL, Vowler SL. A 5-year observational study of the outcome in pediatric cholesteatoma surgery. Otol Neurotol 2007;28:1038-40.
• Roth TN, Ziglinas P, Haeusler R, Caversaccio MD. Cholesteatoma surgery in children: long-term results of the inside-out technique. Int J Pediatr Otorhinolaryngol 2013;77:843-6.
• McGuire JK, Wasl H, Harris T, Copley GJ, Fagan JJ. Management of pediatric cholesteatoma based on presentations, complications, and outcomes. Int J Pediatr Otorhinolaryngol 2016;80:69-73.
• Dodson EE, Hashisaki GT, Hobgood TC, Lambert PR. Intact canal wall mastoidectomy with tympanoplasty for cholesteatoma in children. Laryngoscope 1998;108:977-83.
• Drahy A, De Barros A, Lerosey Y, Choussy O, Dehesdin D, Marie JP. Acquired cholesteatoma in children: strategies and medium-term results. Eur Ann Otorhinolaryngol Head Neck Dis 2012;129:225-9.
• Levenson MJ, Michaels L, Parisier SC. Congenital cholesteatomas of the middle ear in children: origin and management. Otolaryngol Clin North [Am] 1989;22:941-54.
• Yung M, Tono T, Olszewska E, Yamamoto Y, Sudhoff H, Sakagami M, et al. EAONO/JOS Joint Consensus Statements on the Definitions, Classification and Staging of Middle Ear Cholesteatoma. J Int Adv Otol 2017;13:1-8.
• Yetiser S, Hıdır Y, Deveci MS. Morphologic changes of middle ear mucosa in chronic otitis media with or without cholesteatoma. J Int Adv Otol 2008;4:102-8.
• Tono T, Sakagami M, Kojima H, Yamamoto Y, Matsuda K, Komori M, et al. Staging and classification criteria for middle ear cholesteatoma proposed by the Japan Otological Society. Auris Nasus Larynx 2017;44:135-140.
• Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. AmericanAcademy of Otolaryngology- Head and Neck Surgery Ffoundation, Inc. Otolaryngol Head Neck Surg 1995;113:186-7.
• Iino Y, Imamura Y, Hiraishi M, Yabe T, Suzuki J. Mastoid pneumatization in children with congenital cholesteatoma: an aspect of the formation of open- type and closed-type cholesteatoma. Laryngoscope 1998;108:1071-6.
• De Corso E, Marchese MR, Scarano E, Paludetti G. Aural acquired cholesteatoma in children: surgical findings, recurrence and functional results. Int J Pediatr Otorhinolaryngol 2006;70:1269-73.
• Roth TN, Haeusler R. Inside-out technique cholesteatoma surgery: a retrospective long-term analysis of 604 operated ears between 1992 and 2006. Otol Neurotol 2009;30:59-63.
• Dornhoffer JL, Friedman AB, Gluth MB. Management of acquired cholesteatoma in the pediatric population. Curr Opin Otolaryngol Head Neck Surg 2013;21:440-5.