Endoscopic transcanal approach to the middle ear for management of pediatric cholesteatoma

Ghadersohi, Saied; Carter, John M.; Hoff, Stephen R.

doi:10.1002/lary.26654

Cited by 32 publications

(21 citation statements)

References 20 publications

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“…After reviewing the full‐length articles, 182 studies were excluded because they contained a mixture of different patient populations (e.g., mixture of adult and pediatric patients) in the total cohort (n = 163), lacked postoperative outcomes (n = 14), or were review articles (n = 5). Ten studies met all the inclusion criteria for the meta‐analysis; two were prospective and eight were retrospective cohort studies (Table ) . The number of subjects collected for meta‐analysis was 1004, including 513 patients belonging to EES and 491 patients under MES, and the included studies were published between 2015 and 2017.…”

Section: Resultsmentioning

confidence: 99%

Comparison of endoscopic and microscopic ear surgery in pediatric patients: A meta‐analysis

et al. 2018

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Objectives Recently, the endoscope has been increasingly introduced for middle‐ear surgery. To evaluate the postoperative outcomes of endoscopic ear surgery (EES) in pediatric patients, we did a qualitative analysis with a systematic review and quantitative analysis with meta‐analysis of available literature. Methods Studies reporting the comparative surgical outcomes of EES in pediatric patients were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases from database inception through 2017. The selected articles included clinical studies conducted with at least 30 subjects and at least one postoperative parameter, including residual or recurrent cholesteatoma and graft success in tympanoplasty. Two investigators independently reviewed all studies and extracted the data using a standardized form. A meta‐analysis was performed using a random‐effects model and qualitative review was performed on the smaller studies. Results Ten studies were identified as appropriate for quantitative meta‐analysis and 19 studies for qualitative analysis. In the meta‐analysis, residual or recurrence rate of cholesteatoma was significantly lower in the EES group than in the microscopic ear surgery (MES) group (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.38‐0.84, P = .005). The graft success rate of tympanoplasty was not statistically different between EES and MES groups (OR: 0.72, 95% CI: 0.41‐1.26, P = .249). In the qualitative analysis, most of the studies reported similar audiological outcomes after tympanoplasty and success rate of cholesteatoma removal between the two groups. Conclusions It appears that EES reduces the risk of residual cholesteatoma in children and that the success of perforation closure is equivalent to MES. Laryngoscope, 129:1444–1452, 2019

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Section: Resultsmentioning

confidence: 99%

Comparison of endoscopic and microscopic ear surgery in pediatric patients: A meta‐analysis

et al. 2018

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“…Patients who underwent TEES showed no significant difference in rate of tympanoplasty closure or, in mean hearing threshold improvement compared with those in non-TEES patients [ 32 ]. One recent study about TEES outcomes for pediatric cholesteatoma (congenital or acquired) similarly showed the lowest rates of recurrent and residual disease in patients who underwent TEES (recurrence rate of 12.9% and residual rate of 6.5%) [ 17 ]. They showed comparable operating times, recidivism rates, and audiological outcomes between cases that were endoscopically assisted and those that were primarily performed with an endoscope [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…A preliminary report by Kobayashi et al [ 13 ] showed one case (stage III CC) of residual disease within 3 months of initial surgery in 12 patients with CC who underwent EES (8.3% residual rate). Ghadersohi et al [ 17 ] recently reported on 65 pediatric congenital or acquired cholesteatoma cases including 11 CCs; in the CC cases, the endoscope was used as an adjunct to the microscope in one case, and TEES was performed in 10 cases. One of the 11 children revealed residual disease after surgery [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ghadersohi et al [ 17 ] recently reported on 65 pediatric congenital or acquired cholesteatoma cases including 11 CCs; in the CC cases, the endoscope was used as an adjunct to the microscope in one case, and TEES was performed in 10 cases. One of the 11 children revealed residual disease after surgery [ 17 ]. James et al [ 15 ] reported cholesteatoma surgery outcomes including 29 CCs and compared residual rates between the group who underwent microscope surgery followed by endoscopic inspection and the group with endoscope-guided dissection.…”

Section: Discussionmentioning

confidence: 99%

“…Among CCs, stages I, II, and III are confined to the middle ear and can be removed by endoscopic approach alone. Recent studies have reported on the use of exclusively TEES for cholesteatoma removal [ 4 , 13 , 14 , 17 , 18 ]. However, data on patient outcomes following exclusive TEES are still lacking, especially for CCs in children.…”

Section: Introductionmentioning

confidence: 99%

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Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma

Park

Ahn

Moon

2018

Clin Exp Otorhinolaryngol

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Objectives As endoscopic instrumentation, techniques and knowledges have significantly improved recently, endoscopic ear surgery has become increasingly popular. Transcanal endoscopic ear surgery (TEES) can provide better visualization of hidden areas in the middle ear cavity during congenital cholesteatoma removal. We aimed to describe outcomes for TEES for congenital cholesteatoma in a pediatric population.Methods Twenty-five children (age, 17 months to 9 years) with congenital cholesteatoma confined to the middle ear underwent TEES by an experienced surgeon; 13 children had been classified as Potsic stage I, seven as stage II, and five as stage III. The mean follow-up period was 24 months. Recurrence of congenital cholesteatoma and surgical complication was observed.Results Congenital cholesteatoma can be removed successfully via transcanal endoscopic approach in all patients, and no surgical complications occurred; only one patient with a stage II cholesteatoma showed recurrence during the follow-up visit, and the patient underwent revision surgery. The other patients underwent one-stage operations and showed no cholesteatoma recurrence at their last visits. Two patients underwent second-stage ossicular reconstruction.Conclusion Although the follow-up period and number of patients were limited, pediatric congenital cholesteatoma limited to the middle ear cavity could be safely and effectively removed using TEES.

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