Clinical Analysis Of Acquired Middle Ear Cholesteatoma Between Paediatric And Adult Patients

ObjectiveComparing the clinical manifestations,degree of disease progression,and post-operative recovery in patients with acquired middle ear cholesteatoma between children and adults.MethodsA total of 349 patients with acquired middle ear cholesteatoma who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2015 to May 2018 were thoroughly investigated and their complete evaluation data were enrolled in this study.The data were divided into two groups as per their age: childrens' group(142 cases,152 ears)consisting of children under 14 years old,with an average of(9.8±3.0)years old,and an average course of disease of(2.2±2.2)years;adults' group(207 cases,214 ears)with all adults over 18 years old,average(38.1 ±13.3)years old,and an average course of disease of(11.5±13.5)years.The clinical characteristics,intra-operative findings and postoperative follow-up between the two groups were observed and their differences were analyzed.Results1.Clinical symptoms:(1)Clinical symptoms: In children's group,majority patients had ear pus(91.4%),followed by hearing loss,earache,tinnitus,dizziness;In adult's group,patients mainly had hearing loss(98.1%),followed by ear pus earache,tinnitus and dizziness.The clinical manifestations between the two groups were statistically significant(p <0.05).(2)Preoperative complications: Labyrinth fistula was the most common in both groups(10.5% in children and 10.3% in adults).Peripheral facial paralysis(1.3%,3.3%),subperiosteal abscess(4.6%,0.5%)and sigmoid sinus thrombosis(1.3%,0.5%)were less common.The incidence of subperiosteal abscess in children was significantly higher than that in adults(p <0.05)..2.Results of the examination:(1)Tympanic membrane condition: There was no significant difference between the childrens' group and the adults' group,and the both groups were most likely to have perforation of the tympanic membrane pars flaccida,(p >0.05).(2)Preoperative hearing: The preoperative hearing loss was relatively severe in the children group.The mean value of the air bone gap in children group was(34.1±12.4)dBHL,and that in adult group was(31.2±11.7)dBHL.The difference between the two groups was statistically significant(p <0.05).3.Imageological diagnosis and intraoperative conditions:(1)The type of mastoid air cells: the mixed type(55.3%)and gasified type(26.3%)are the most common in children;sclerosis type(71.0%)and mixed type(21.5%)are the most common in adult.The difference between the two groups of data was statistically significant(p <0.05).(2)The involvement of cholesteatoma: The two groups were most prone to invade the mastoid cavity,sinus tympani,epitympanum,and posterior tympanum,but more in adults.Although cholesteatoma rarely invades the eustachian tube,the incidence was higher in children(p <0.05).(3)Ossicular damage: In both groups,incus was the most commonly damaged,and the difference between the two groups was not statistically significant(p >0.05).While,the effect of cholesteatoma on stapes destruction in children was significantly higher than that in adults(p <0.05).(4)Facial nerve exposure: In both groups,the most common segment was the tympanum segment,followed by the pyramid segment and mastoid segment.The difference between the two groups was not statistically significant(p >0.05).(5)Semi-circular canal bone destruction: The two groups of horizontal semicircular canal bone destruction are the most common,followed by the superior semicircular canal and posterior Semicircular canal.The difference between the two groups was not statistically significant(p >0.05).(6)Sigmoid sinus and dural plate bone destruction: In the children group there was higher incidence than the adult group,and the difference was statistically significant(p <0.05).4.Postoperative follow-up:(1)Postoperative hearing recovery : Both groups had significant improvement in hearing compared with preoperative,but the air bone gap in children group(22.8±11.9)dBHL,was greater than that in adult group(21.6 ± 7.6)dBHL,and the difference was statistically significant(p < 0.05);(2)A total of 8 ears were not completely dry,and 2 case of children had recurrence of cholesteatoma after surgery,and the rest obtained dry ears;(3)All patients with facial paralysis in the two groups recovered to the level of HB?~III.Conclusions1.For acquired middle ear cholesteatoma,children have short disease course and rapid development of disease.2.For acquired middle ear cholesteatoma,the mixed type and gasified type are the most common in children;sclerosis type is the most common in adult.Children are more likely to have retroauricular subperiosteal abscess.3.Cholesteatoma in children is highly invasive,which causes great damage to the sound transmission structure in the middle ear of children.Moreover,the stapes bone is damaged seriously,resulting in the preoperative hearing loss worse than adults.Sigmoid sinus and dural plate are more susceptible to bone destruction than adults.Surgical treatment can obtain better results.4.Postoperative children have high recurrence rate,so it's necessary to undergo regular and long-term follow-up visits is.