Ivan Baljošević1*, Ognjen Milicevic2 and Stefan Popovic1
1ENT Department, Mother and Child Institute, Belgrade, Faculty of Dentistry, Pancevo, Serbia
2Department of Medical Statistics and Informatics, Medical Faculty University of Belgrade, Belgrade, Serbia
*Corresponding Author: Ivan Baljošević, ENT Department, Mother and Child Institute, Belgrade, Faculty of Dentistry, Pancevo, Serbia.
Received: February 14, 2022; Published: April 11, 2022
Objectives: Congenital cholesteatoma presents pathological lesion that develops behind intact membrane tympani. Objective of this paper is to present our experience in diagnostics and treatment of congenital cholesteatoma at children.
Material and Methods: Our study represents a retrospective review of 17 children who underwent surgery for congenital cholesteatoma from 2012. to 2019. at the ORL Department, Mother and Child Health Care Institute, Belgrade, Serbia. All patients had congenital cholesteatoma present on one ear. Diagnoses were made from between 3 months to one year after presentation (an average of 6.3 months).
Basic criteria in diagnosis of congenital cholesteatoma were presence of white mass behind the intact timpani membrane with no data on otorrhea, perforation of membrane timpani or surgical interventions. Staging of the cholesteatomas was based on the classification suggested by Potsic.
Results: Congenital cholesteatoma confined to the middle ear cavity was present in 16 (94%) patients, the majority of whom had involvement of multiple quadrants (9 patients or 57%), in 4 (25%) cases CC was localized to the posterior quadrants, in 2 (12%) to the anterior quadrants and in one (6%) case to the anterosuperior and posterosuperior quadrants. One case involved congenital cholesteatoma confined to the mastoid cavity. Preoperative contralateral middle ear disease was absent in 12 (70%) cases, whereas secretory otitis media (SOM) was identified in the contralateral ear in 3 (18%) cases and adhesive otitis in 2 (12%) cases. The following surgical interventions were performed: tympanoplasty type I in 3 (17%) patients with congenital cholesteatoma localized to the anterior quadrants, radical modified tympanomastoidectomy (canal wall up) and tympanoplasty type II in 5 (30%) patients, canal wall down mastoidectomy and tympanoplasty type III in 8 (47%) and simple (cortical) mastoidectomy in 1 (6%) patient (where the cholesteatoma was confined to the mastoid cavity). All patients were followed up 24 ± 6,4 months postoperatively. Recurrent cholesteatoma was diagnosed in 2 (12%) patients, one in a patient who had CWU and one in a patient who had CWD mastoidectomy performed. In both cases a small aplastic poorly pneumatized mastoid was encountered during surgery and both patients had concomitant contralateral middle ear disease (SOM and adhesive otitis media respectively).
Conclusions: Congenital cholesteatoma is characterized by insidious onset with predominantly ipsilateral CHL, which is why in many cases patients are erroneously treated for otitis media with effusion prior to establishment of correct diagnosis. Furthermore, the insidious nature of disease calls for a high index of suspicion in ORL specialists and indeed pediatricians performing newborn hearing screening and hearing tests in preschool children as CCs are most commonly diagnosed by that age. Disease stage is a significant risk factor for recurrence.
Keywords: Congenital Cholesteatoma; Stage; Surgical Procedures
Citation: Ivan Baljošević., et al. “Surgical Treatment Of Congenital Cholesteatoma of Middle Ear at Children".Acta Scientific Orthopaedics 5.5 (2022): 40-46.
Copyright: © 2022 Ivan Baljošević., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.