| Objective: Using real-world research methods to summarize and collate the clinical data of middle ear cholesteatoma in Xiangya Hospital of Central South University in the past 5 years,we will further improve our understanding of the essential characteristics of it and its therapeutic effect.Method: From January 2017 to September 2021,by collecting and collating the real-world data of 1005 ear(961 people)who had suffering with middle ear cholesteatoma and undergoing surgery in the otolaryngology ward of Xiangya Hospital of Central South University,we retrospectively analyzed their demographic characteristics,clinical manifestation characteristics and surgical and perioperative related data.Result:(1)This study included the demographic data of 961 patients,447 females and 514 males.Their average age was(38.16±16.15)years old,from 3 to 81.It included Han Chinese and 5 ethnic minorities and it covered 24 provincial-level administrative regions,all 14 prefecture-level administrative regions in Hunan Province.Comparing the sex,age,ethnicity,place of origin,education level,marital status,blood type and occupational distribution of patients with the census data of Hunan Province,the analysis shows that the proportions of patients who aged 15 to 59 years old,Han Chinese,nationality in Changsha City and Yueyang City,high school and university education,marital status with spouse,blood type B type,and occupation as tertiary industry were higher.(2)This study included the clinical manifestation data of 1005 ears,872 primary surgery and 133 second/multiple surgery.The clinical manifestations of the primary surgical ears were most common in hearing loss(94.15%),followed by otorrhea(87.84%);Clinical manifestations of secondary/multiple surgical ears were most common in otorrhea(86.47%),followed by hearing loss(76.49%).Preoperative examination found that the proportion of moderate hearing loss in the primary surgical ears was higher than that of the second/multiple surgical ears,while the proportion of profound hearing loss in the primary surgical ears was lower than that of the second/multiple surgical ears.Among the extracranial complications and pathological conditions,the incidence of facial nerve exposure was highest(33.72%),followed by labyrinth fistula(8.94%).Among the intracranial complications,meningitis,peri-sigmoid sinus lesions,and brain abscess respectively accounted for 1.15%,0.57%,and 0.34%.The proportion of children cholesteatoma with symptoms of hearing loss was lower than adults,but there was no significant difference in the detection rate of preoperative hearing loss between the two.(3)In this study,the surgery-related data of 1005 ears were included,of which 872 primary surgery and 133 second/multiple surgery.In the low-stage and the primary surgical ears,the proportion of lesion clearance and functional reconstruction surgery was higher;In high-stage and secondary/multiple surgical ears,the proportion of simple lesion clearance surgery was higher.And the dry ear rate of lesion clearance and functional reconstruction surgery was higher than that of simple lesion clearance surgery.In lesion clearance and functional reconstruction surgery,there was no significant differences in postoperative hearing recovery and postoperative quality of life scores during two types of Tympanoplasty with Mastoidectomy,but there was a higher residual/recurrence rate in the canal wall up(CWU).Children cholesteatoma was more likely to involve the mastoid area,and surgical options were more likely to include mastoid resection or radical resection.The residual/recurrence rate in pediatric cases with CWU was higher than in adult cases.With the introduction of endoscopy and the improvement of doctors’ techniques,the proportions of lesion clearance and functional reconstruction surgery? single-approach of trans-auricular and dual-approach(CWU)were increasing and the proportions of singleapproach of trans-posterior mastoid were decreased in patients.There was no significant difference in postoperative quality of life scores compared to the two surgical approaches in the single-approach,but the singleapproach of trans-auricular in Radical Mastoidectomy surgery had a shorter operation time.Conclusion:(1)The source of patients with cholesteatoma in this study covered 24 provincial-level administrative regions,and all 14prefecture-level administrative regions in Hunan Province;In view of a demographic point,the proportions of patients who aged 15 to 59 years old,Han nationality,nationality in Changsha City and Yueyang City,high school and university education,marital status with spouse,blood type B type,and occupation as tertiary industry were higher.(2)Although the symptoms of most patients were mainly hearing loss and otorrhea,there were still some patients with middle ear cholesteatoma have not hearing loss and have not otorrhea when they were not infected;Some patients with middle ear cholesteatoma who had already undergoing surgery may had not any symptoms when they developed cholesteatoma residual/recurrence,so regular follow-up and review of high-resolution CT of the temporal bone were required;Although some children had not symptoms of hearing loss,hearing loss can be detected.(3)Treatment of middle ear cholesteatoma was still dominated by surgery;The choice of surgical method and surgical approach should consider staging,update of auxiliary tools,number of surgeries,children/adults,and whether it is a unilateral surgical ear,which will affect postoperative hearing,postoperative quality of life,dry ear rate,residual/recurrence rate,operation time,and postoperative hearing recovery;With the passage of time and the improvement of doctors’ techniques,the surgical method was more inclined to choose the lesion clearance and functional reconstruction surgery;In the same choice of CWU,the residual/recurrence rate in children was significantly higher than in adult cases,reminding us that we need to be more cautious in the choice of surgical procedures in pediatric cases. |
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