THE INFLUENCE OF MIDDLE EAR INFECTIONS ON CHARACTERISTICS OF CONGENITAL CHOLESTEATOMA
Introduction
In general, the clinical diagnosis of congenital cholesteatoma (CC) is made based upon the certain criteria: presence of cholesteatoma behind an intact tympanic membrane and operative findings without any demonstrable connection with the external auditory canal.1 However, if there is middle-ear infection (MEI) or a history of otitis media, it sometimes might be difficult to diagnose because of the high incidence of acute otitis media in children. The aim of this paper is to discuss the location of CC and the influence of MEI on the characteristics of CC.
Method
We investigated 46 cases of cholesteatoma, which had no demonstrable connection with the external auditory canal and which had been confirmed by surgery. Mean age was 10.6 ± 11.4 yrs; gender: 14 female and 32 male; affected side: 30 right ear and 16 left ear. All cases were unilateral. The location of CC in the quadrant and the influence of MEI on the location of CC were discussed.
Results
Applying the Potsic staging system,2 21% was single-quadrant CC (stage I), 7% was multiple-quadrant CC (stage II), 66% was ossicles CC (stage III), and 12% was mastoid CC. The locations of CC were divided into four categories, that is, ASQ (antero-superior quadrant), AIQ (antero-inferior quadrant), PSQ (postero-superior quadrant), PIQ (postero-inferior quadrant) and mastoid extension. Based upon the above-mentioned categories, 22% occurred in the ASQ, 0% in the AIQ, 65% in the PSQ, 0% in the PIQ and 13% in the mastoid extension (Fig. 1). Changes of CC location by age were investigated (Table 1). PSQ CC tends to increase with age, whereas ASQ tends to decrease. In addition to that, there were some ASQ CC cases which disappeared with age.
There were 20 cases of CC with MEI or the history of otitis media, in which the mean age was lower and PSQ+ASQ and mastoid extension occurred more frequently; and 26 cases of CC without any history of otitis media in which the mean age was two times higher and ASQ occurred frequently. Moreover, the mastoid air cells were sclerotic, ossicular involvement and ‘closed-type’ cholesteatoma were prominent, and the size of the CC was larger in the CC cases with MEI or the history of otitis media group.
Fig. 1. Location of CC. PSQ CC occurred five times more than ASQ CC.
Table 1. Changes of CC Location by age. PSQ CC tends to increase with age, whereas ASQ tends to decrease.
Conclusion
PSQ CC occurred five times more than ASQ CC. As age increased, PSQ CC increased and ASQ CC decreased. Some of the ASQ CC had disappeared during the observation.
As for the influence of MEI on the characteristics of CC, in the group of no MEI, the patients’ ages were higher, the mastoid air cells were significantly more well-pneumatized and ossicular involvements were less noticed. Additionally, open-type CC and small PSQ CC diagnosed as middle-ear anomalies prior to surgery were clearly recognized in this group. PSQ CC tends to expand and ASQ CC tends to shrink or sometimes disappear. It appears that in the presence of MEI CC tends to be larger and closed type cholesteatoma, and frequently erodes IS portion at a younger age.
In conclusion, our study indicates that the presence of MEI affects the location, form, size, extension of the CC and the prognosis of the diseases, and pneumatization of mastoid air cells and ossicular involvement.
References
1.Derlacki EL. Congenital cholesteatoma of the middle earand mastoid. Arch Otolarybgol 97:177–182, 1973
2.Potsic WP, Samadi DS, Marsh RR and Wetmore RF. A staging system for congenital cholesteatoma. Arch Otolarybgol Head Neck Surg 128:1009–1012, 2002
Address for correspondence: Takao YABE, M.D., Ph.D., Director of the Department of Otolaryngology, Tokyo Metropolitan HIROO Hospital, 2–34-10, Ebisu, Shibuya-ku, Tokyo, Japan. takao_yabe@tmhp.jp
Cholesteatoma and Ear Surgery – An Update, pp. 147–148
Edited by Haruo Takahashi
2013 © Kugler Publications, Amsterdam, The Netherlands