CONGENITAL CHOLESTEATOMA AMONG SCHOOL-AGE CHILDREN IN HEARING SCREENING PROGRAM
Introduction
Congenital cholesteatoma may occur in different age groups. It can be located in many sites including the cerebellopontine angle, the inner ear, the mastoid, the petrosus apex, the middle ear, the tympanic membrane, the external auditory canal.1 From the clinical point of view it is very important to detect it as early as possible. Congenital cholesteatoma may lead to destruction of ossicular chain, perforation of the tympanic membrane and destruction of other temporal bone areas. Often patients report to a specialist when the cholesteatoma is large therefore very often the surgery includes reconstruction of the ossicular chain and is connected with considerable risk during and after surgery. Hearing screening in school-age children have been performed in 2008–2011 in Poland. The program included children at the age of seven-12 years old.2,3 The main aim of the program was to detect hearing disorders which were not observed by the parents or teachers. The paper presents result of the second and third part of the program focused on congenital cholesteatoma detected among children who have not been under supervision of a specialist.
Material and method
The study includes children from Warsaw who underwent hearing screening examination in 2008–2010. This homogenic group includes 27,740 children at the age of 12 years. Data have been collected for three months (April, May, June) from 662 schools in Warsaw.4 The data were collected by specially trained students, testers and professionals. Sensory Examination Platform™ was used with special data software for the purposes of this program. The platform is constructed on the basis of an efficient, central computer system and portable computers that are equipped with audiometric headphones and a button for the tested person. Computers communicate safely with the central database via the Internet. The Sensory Examination Platform™ (Fig. 1) provides the following examinations and tests:
•Audiometric testing: ‘Audiogram’
•Hearing screening test: ‘I can hear’™
•Speech screening test: ‘I can speak’ ™
•Sight screening test: ‘I can see’ ™
•Audiological survey
•Test ‘DDT’ – digital dichotic test
•Test ‘GDT’ – gap detection test
Fig. 1. Sensory examination platform.
In this study we used: Audiometric test, Audiological survey, DDT test and ‘I can hear’ test.3 Survey was especially important during this program, because the children with medical history of cholesteatoma were excluded from the analysis (only in part dedicated to that manuscript). Positive results of the test have been obtained by 16.5% of children who afterwards have been examined more profoundly. Of all the tested children, 8.6% gave a positive response in the audiometric test which is very important from the congenital cholesteatoma point of view; 5.6% constituted children with minimum one result on the level 21–30 dB SPL, 1.7% - 31–40 dB SPL, 1.1% - over 41dB SPL. Unilateral hearing disorders were found in 61.1% and bilateral in 38.9% of the positive results. They were referred to Institute of Physiology and Pathology of Hearing or cooperating centers in Poland for further examination. Ninety-two percent of the children from the selected group came for a control visit.
The criteria of positive result were minimum one response on level higher than 20dB SPL in audiometry. Children who came for the control visit were examined by a specialist with micro-otoscopy and video-otoscopy. Forty-three children were found with congenital cholesteatoma (0,046/10000). This included 41 cases of unilateral congenital cholesteatomas and two bilateral cases. Cholesteatomas in all cases have been confirmed surgically.
Results
Our results present that hearing disorders among school age children are a serious problem. Of parents of the children with hearing problems, 65.3% had not observed any problems prior to the examination.2 Our research confirms that early identification of hearing disorders gives chances to provide adequate treatment earlier and with lower possible complications. The hearing-screening program provides all children with equal chances to develop properly as well as gives better education opportunities what was emphasized in the conclusion of European Union Council.5
References
1.Merchant SN, Nadol JB (eds.) Schuknecht’s Pathology of the Ear: Shelton, PMPH-USA, 2010
2.Skarzynski PH et al. Hearing screening program in school-age children in western poland. Int Adv Otol 7:(2)194–200, 2011
3.Skarzynski H, Kochanek K, Senderski A, Skarzynski PH, Ludwikowski M, Kopaczewski M, Bruski L. Organization of the hearing screening examinations in polish schools in rural areas and small towns. Cochlear Implants Int 11:143–147, 2010
4.Sliwa, Hatzopoulos S, Kochanek K, Piłka A, Senderski A, Skarżyński PH. A comparison of audiometric and objective methods in hearing screening of school children. A preliminary study. Int J Pediatr Otorhinolaryngol 75:483–488, 2011
5.Skarzynski H et al. EU Council Conclusion on early detection and treatment of communication disorders in children, including the use of e-health tools and innovative solutions. Journal of Hearing Science 2(1):SR49–50, 2012
Address for correspondence: Piotr H. Skarzynski, p.skarzynski@ifps.org.pl
Cholesteatoma and Ear Surgery – An Update, pp. 255–256
Edited by Haruo Takahashi
2013 © Kugler Publications, Amsterdam, The Netherlands