Advertisement

Trans-canal endoscopic ear surgery and canal wall-up tympano-mastoidectomy for pediatric middle ear cholesteatoma

  • Eran GliksonEmail author
  • Gilad Feinmesser
  • Doron Sagiv
  • Michael Wolf
  • Lela Migirov
  • Yisgav Shapira
Otology

Abstract

Purpose

To evaluate clinical parameters, outcomes and complications of transcanal endoscopic ear surgeries (EES) and canal wall-up tympano-mastoidectomy (CWU) for middle ear cholesteatoma in children and to compare between the two surgical approaches.

Methods

A retrospective chart review of all children (< 16 years) who underwent surgery for cholesteatoma involving the middle ear only with a minimal follow-up period of 12 months. Demographic features, site and extent of disease, outcome and complications were reviewed and compared between the groups.

Results

Thirty EES and 19 CWU were included. The overall disease relapse rates in the EES and CWU groups were 20% (n = 6, residual rate = 10%, recurrence rate = 10%) and 47% (n = 9, residual rate = 11%, recurrence rate = 37%), respectively (p = 0.04), with mean duration of follow-up of 32.6 and 37.2 months, respectively. In the EES and CWU groups, the most common site of residual disease was the mastoid cavity/antrum (n = 2, 66% and n = 2, 100%, respectively). Most recurrences involved the epitympanum and extended into the tympanic cavity (n = 2, 66%) in the EES group and into the tympanic cavity, posterior mesotympanum and mastoid cavity/antrum (n = 3, 43%, each) in the CWU group. The overall complication rates in the EES and CWU groups were 10% (n = 3) and 11% (n = 2), respectively (p = 0.61).

Conclusions

Endoscopic ear surgeries in children were found to be an acceptable and safe technique for the treatment of cholesteatoma limited to the middle ear cavity. A better overall success rate and a similar complication rate were found in the EES group when compared to CWU.

Keywords

Cholesteatoma Endoscopic ear surgery Pediatric Canal wall up Mastoidectomy 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was reviewed and approved by the Research Ethics Committee of the Chaim Sheba Medical Center, Tel-Hashomer, Israel (application number: 2581-15-SMC).

References

  1. 1.
    Sohet JA, De Jong AL (2002) The management of pediatric cholesteatoma. Otolaryngol Clin N Am 35:841–851CrossRefGoogle Scholar
  2. 2.
    Glasscock ME III, Dickins JR, Wiet R (1981) Cholesteatoma in children. Laryngoscope 91:1743–1753PubMedGoogle Scholar
  3. 3.
    de Zinis LO, Tonni D, Barezzani MG (2010) Single-stage canal wall-down tympanoplasty: long-term results and prognostic factors. Ann Otol Rhinol Laryngol 119:304–312CrossRefPubMedGoogle Scholar
  4. 4.
    Haginomori S, Takamaki A, Nonaka R et al (2008) Residual cholesteatoma: incidence and localization in canal wall down tympanoplasty with soft-wall reconstruction. Arch Otolaryngol Head Neck Surg 134:652–657CrossRefPubMedGoogle Scholar
  5. 5.
    Sanna M, Facharzt AA, Russo A et al (2009) Modified Bondy’s technique: refinements of the surgical technique and long-term results. Otol Neurotol 30:64–69CrossRefPubMedGoogle Scholar
  6. 6.
    Tomlin J, Chang D, McCutcheon B et al (2013) Surgical technique and recurrence in cholesteatoma: a meta-analysis. Audiol Neurootol 18:135–142CrossRefPubMedGoogle Scholar
  7. 7.
    Thomassin JM, Duchon-Doris JM, Emram B et al (1990) Endoscopic ear surgery. Initial evaluation. Ann Otolaryngol Chir Cervicofac 107:564–570PubMedGoogle Scholar
  8. 8.
    Migirov L, Shapira Y, Horowitz Z et al (2011) Exclusive endoscopic ear surgery for acquired cholesteatoma: preliminary results. Otol Neurotol 32:433–436CrossRefPubMedGoogle Scholar
  9. 9.
    Badr-El-Dine M (2002) Value of ear endoscopy in cholesteatoma surgery. Otol Neurotol 23:631–635CrossRefPubMedGoogle Scholar
  10. 10.
    Ayache S, Tramier B, Strunski V (2008) Otoendoscopy in cholesteatoma surgery of the middle ear. What benefits can be expected? Otol Neurotol 29:1085–1090CrossRefPubMedGoogle Scholar
  11. 11.
    Tarabichi M (2004) Endoscopic management of limited attic cholesteatoma. Laryngoscope 114:1157–1162CrossRefPubMedGoogle Scholar
  12. 12.
    Presutti L, Gioacchini FM, Alicandri-Ciufelli M et al (2014) Results of endoscopic middle ear surgery for cholesteatoma treatment: a systematic review. Acta Otorhinolaryngol Ital 34(3):153–157PubMedPubMedCentralGoogle Scholar
  13. 13.
    Marchioni D, Villari D, Mattioli F et al (2013) Endoscopic management of attic cholesteatoma: a single-institution experience. Otolaryngol Clin N Am 46:201–209CrossRefGoogle Scholar
  14. 14.
    Marchioni D, Soloperto D, Rubini A et al (2015) Endoscopic exclusive transcanal approach to the tympanic cavity cholesteatoma in pediatric patients: our experience. Int J Pediatr Otorhinolaryngol 79:316–322CrossRefPubMedGoogle Scholar
  15. 15.
    Hunter JB, Zuniga MG, Sweeney AD et al (2016) Pediatric endoscopic cholesteatoma surgery. Otolaryngol Head Neck Surg. 154(6):1121–1127CrossRefPubMedGoogle Scholar
  16. 16.
    Ghadersohi S, Carter JM, Hoff SR (2017) Endoscopic transcanal approach to the middle ear for management of pediatric cholesteatoma. Laryngoscope. 127:2653–2658CrossRefPubMedGoogle Scholar
  17. 17.
    Osborn AJ, Papsin BC, James AL (2012) Clinical indications for canal wall-down mastoidectomy in a pediatric population. Otolaryngol Head Neck Surg 147:316–322CrossRefPubMedGoogle Scholar
  18. 18.
    Glikson E, Yousovich R, Mansour J, Wolf M, Migirov L, Shapira Y (2017) Transcanal endoscopic ear surgery for middle ear cholesteatoma. Otol Neurotol. 38(5):e41–e45CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otolaryngology, Head and Neck SurgerySheba Medical CenterTel-HashomerIsrael
  2. 2.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

Personalised recommendations