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Surgical treatment of paediatric cholesteatoma: Long-term follow up in comparison with adults
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
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2012 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 76, no 8, 1091-1097 p.Article in journal (Refereed) Published
Abstract [en]

Objective: This study was designed to analyse long-term results after surgery of acquired (ACH) and congenital cholesteatoma (CCH) of the middle ear in children and compare these with adults.

Methods: Computer-based analysis of consecutively operated paediatric patients for ACH and CCH in a tertiary referral centre was made in 57 cases under the age of 12 operated 1983-2004 by three surgeons using identical technique. A canal wall down and total reconstruction procedure (TRP) with obliteration of the mastoid cavity, canal wall reconstruction, ossiculoplasty with consistent use of autologous bone and an "aeration enhancement procedure" (AEP) with silicon sheet in selected cases were used. Pre- and post-operative PTA (0.5-3 kHz) and pure-tone average air-bone gap (PTA-ABG) together with surgical parameters were assessed 1, 3 and 6 years following surgery.

Results: Results showed stable hearing over 6 years with low incidence of persistent and recurrent disease comparable with results from adult patients. In nearly half of the cases, silastic sheeting was used. In 21 cases, stapes was eroded. Bone conduction thresholds levels remained unaffected 6 years after surgery. No deaf ears, postoperative facial dysfunction or other lesions related to surgery were observed. Six years after surgery every evaluated ear was found to be water-resistant and infection-free.

Conclusion: Our results suggest that one-stage eradication of ACH and CCH in children using total reconstruction procedure (TRP) provide long-term improvement or preservation of hearing, with a low incidence of persistent or recurrent disease. No difference in surgical outcome between children and adults was found.

Place, publisher, year, edition, pages
2012. Vol. 76, no 8, 1091-1097 p.
Keyword [en]
Cholesteatoma surgery, Children, Silastic sheeting, Hearing results, Surgical results, Staging, Long-time follow-up
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-179557DOI: 10.1016/j.ijporl.2012.04.006ISI: 000306449300005OAI: oai:DiVA.org:uu-179557DiVA: diva2:545445
Available from: 2012-08-20 Created: 2012-08-20 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Middle Ear Cholesteatoma: Surgical Treatment, Follow-up and Hearing Restoration
Open this publication in new window or tab >>Middle Ear Cholesteatoma: Surgical Treatment, Follow-up and Hearing Restoration
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Although middle-ear cholesteatoma is a major topic in otological research, its etiology and pathogenesis remain unclear. Pediatric cholesteatoma is considered more aggressive than adult cholesteatoma, as it has a higher rate of growth, is more often infected and exhibits wider extension. Higher incidence of residual and recurrent disease after surgical treatment of pediatric cholesteatoma has been observed in most studies. In this study, the results are presented from a canal wall down (CWD) obliteration technique used in 330 adult patients (Paper I) with cholesteatoma, evaluated at 1, 3 and 6 years following surgery. Additionally, results are offered from 57 pediatric patients (Paper II) using identical surgical technique and compared with adults. The surgical and hearing outcomes in both groups showed a low incidence of residual and recurrent disease and a high rate of ear water resistance without infection. The results were unrelated to the severity and extension of disease, as well as to age and previous surgery. No differences were found in outcomes between adult and pediatric cholesteatoma patients.

The thesis also describes the use of diffusion-weighted magnetic resonance imaging (DW-MRI) (Paper III) in follow-up examinations of adult cholesteatoma patients undergoing surgical treatment. Non-echo planar diffusion-weighted imaging (Non-EPI DW-MRI)increased the accuracy of clinical examinations. It is concluded that the use of non-EPI DW-MRI should be mandatory in clinical follow-ups after cholesteatoma surgery. In Paper IV a relatively new mode of hearing rehabilitation was investigated, with an active middle ear implant (AMEI), in patients with chronically disabled ears. Functional hearing results were compared with the previous use of conventional hearing aids before and after AMEI implantation. Moreover, the consequences of positioning of the implant in the middle ear were evaluated using cone beam computed tomography (CBCT), a modification of conventional computed tomography. The hearing results, assessed with AMEI, were found to be less dependent on the precise positioning of the floating mass transducer(FMT) against the round window membrane (RWM) than was anticipated. Further, the hearing results were noted to be comparable with those with conventional hearing aids and even superior at high frequencies.

 

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 48 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 905
National Category
Medical and Health Sciences
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:uu:diva-198121 (URN)978-91-554-8672-3 (ISBN)
Public defence
2013-06-12, Enghoffsalen, ingång 50, Akademiska Sjukhuset, Uppsala, 13:15 (Swedish)
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Supervisors
Available from: 2013-05-22 Created: 2013-04-09 Last updated: 2013-08-30Bibliographically approved

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Edfeldt, LennartKinnefors, AndersStrömbäck, KarinKöbler, SusanneRask-Andersen, Helge

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