Cholesteatoma surgery in the pediatric population: remaining challenges in the era of mastoid obliteration.

Autor: Kroon VJ; Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands. v.j.kroon@students.uu.nl.; Faculty of Medicine, University Utrecht, Utrecht, The Netherlands. v.j.kroon@students.uu.nl., Mes SW; Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.; Otolaryngology-Head and Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands., Borggreven PA; Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands., van de Langenberg R; Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands., Colnot DR; Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands., Quak JJ; Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands. JQuak@diakhuis.nl.
Jazyk: angličtina
Zdroj: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery [Eur Arch Otorhinolaryngol] 2023 Apr; Vol. 280 (4), pp. 1713-1722. Date of Electronic Publication: 2022 Oct 08.
DOI: 10.1007/s00405-022-07669-0
Abstrakt: Purpose: To present the first pediatric study on the safety and efficacy of mastoid obliteration using S53P4 bioactive glass (BAG) for cholesteatoma surgery.
Methods: A single-center retrospective cohort study was conducted. Inclusion criteria were pediatric cases (≤ 18 years) and at least at least one year of follow-up including non-echo planar diffusion-weighted MRI to assess cholesteatoma recidivism. Both canal wall up (CWU) and canal wall down (CWD) procedures were evaluated.
Results: A total of 61 cases (56 patients) were included. Most cases had an otologic history before the development of the cholesteatoma. CWU procedure was performed in 18 cases (30%) and CWD procedure in 43 cases (70%). The cholesteatoma recidivism rate was 33% after a mean follow-up period of 58 months. Kaplan-Meier curve estimated a 5-year recidivism rate of 40%. Few complications were seen that were all minor and resolved spontaneously or after local or systemic treatment. Control of the infection (merchant grade 0-1) was achieved in 98% of the cases. Closure of the air-bone gap within 20 dB was achieved in 22% of the cases with complete audiometric evaluation.
Conclusion: In this MRI-controlled study, we show the safety and efficacy of S53P4 BAG for mastoid obliteration in a pediatric cholesteatoma cohort. Postoperative complications were both rare and minor, and a dry ear was achieved in almost all patients. Nevertheless, persistent hearing loss and the apparent high recidivism rate reflect the challenging nature of pediatric cholesteatoma.
(© 2022. The Author(s).)
Databáze: MEDLINE
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