| Objective To analyze the clinical characteristics and postoperative effect of middle ear cholesteatoma in children,so as to provide reference for further improving the diagnosis and treatment of pediatric cholesteatoma.Methods Between January 2015 and January 2019,30 children(30 ears)aged 5-14 with complete clinical data and follow-up data were selected from the otology ward of Shengjing Hospital.Combined with JOS staging standard study and analysis of its clinical manifestations,clinical stages,surgical program,treatment effects and postoperative follow-up data.Results 1.Clinical symptoms: Among the 30 cases,26 were male and 4 were female,with an average age of(10.50 ± 2.60)years and a history of 2 weeks to 13 years,which average(2.56 ± 3.07)years;the most common clinical manifestation was purulent ear(86.7%),followed by hearing loss(80.0%),earache(30.0%),tinnitus(23.3%);the average preoperative air conduction hearing threshold was(60.94 ± 14.10)dB,of which 25 cases(83.3%)were conductive deafness and 5 mixed deafness(16.7%),16 cases(53.3%)of mild and moderate hearing loss,14 cases(46.7%)of severe and extremely severe hearing loss,the correlation analysis of course time and preoperative hearing was not statistically significant(p> 0.05);22 cases(73.4%)of JOS stage II accounted for the most,4 cases(13.3%)of stage I and stage III respectively,and the correlation analysis of JOS stage with course time and preoperative hearing was not statistically significant(p> 0.05).2.Intraoperative findings:27 cases underwent CWD(among 13 cases of reconstruction of external auditory canaland 14 cases of conchaplasty)and 3 cases underwent CWU;All patients underwent one-stage hearing reconstruction,including 8 cases(26.7%)with PORP,15 cases(50.0%)with TORP and 7 cases(23.3%)with autogenous bone;the epitympanum(86.7%)was the most common involved site,followed by the tympanum(83.3%),mastoid cavity and tympanic antrum(73.3%),supratubal recess(33.3%)and tympanic sinus(13.3%);the malleus and incus were both involved in different degrees(100%),more than half of them(53.3%)had structural damage in the stapes,semicircular canal damage and destruction of the canopy in 4 cases(13.3%)respectively,and the horizontal segment of the facial nerve was exposed in 1 case(3.3%).3.Treatment effect: The patients were followed up for more than 12 months.The dry ear time ranged from 1 to 6 months,with an average of(2.68 ± 1.49)months.The mean postoperative air conduction hearing threshold was(45.0 ± 16.05)dB,of which 23 cases(76.7%)had an effective improvement in hearing.The difference of postoperative hearing and preoperative was statistically significant(t = 7.187,p< 0.001).There was a moderate negative correlation between JOS stage and the effective improvement of postoperative hearing(R=-0.458,p<0.001).There was no statistical significance between JOS stage and postoperative hearing as well as dry ear time(p> 0.05).Conclusions The main clinical manifestation of middle ear cholesteatoma in children is purulent ear and hearing loss,with an average course of 2.5 years;When children are hospitalized,they are often accompanied by different degrees of involvement of ossicular chain,so no matter the course of disease and the severity of clinical symptoms,they should be operated as soon as possible to achieve more significant therapeutic effect;Stage II of JOS is the most common stage,while patients of stage III have more violations of semicircular canal and tegmental bone;the effect of primary hearing reconstruction is significant,the lighter the stage is,the more obvious the improvement of postoperative hearing is;the average dry ear time is 2.5 months,and the dry ear time of CWU is relatively shorter than that of CWD;we should attach importance to the regular and long-term follow-up after surgery so as to pay attention to the postoperative complications,recurrence and the incidence of contralateral ear. |
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