www.orl-marseille.com      Congenital middle ear    cholesteatomas in childrenA Abbas, R Nicollas, I Sudre, H Belaïche, S ...
Why?   Problem: early diagnosis   Comparative study with acquired cholesteatoma in    children   Objective: to determin...
Material and methods Monocentric and comparative prospective study from 1994 to 2005, n = 322 cases of cholesteatoma in ...
Results                         Clinical    n=61                          otalgia                                         ...
Results                                Initial location n=61 anterior superior                     posterior superior     ...
Surgical results                       Procedure n=61 limited pattern (anterior superior): 23%             exploratorytym...
Comparative study (κ     2   Student)     Congenital (n=61)    Acquired (n=261)Asymptomatic        31%      8%Deafness    ...
Anatomical presentation                 Congenital (n = 61)   Acquired (n = 261)“cystic” closed pattern      36%          ...
Contralateral ear             Congenital (n=61)   Acquired (n=261)Normal                    84%           56%SOM          ...
Postoperative hearing assessments      Congenital (n=61)                     Acquired (n=261)Preoperative ABG (dB):       ...
Discussion   Levenson’s criterias:     – CC children with AOM     – under-estimated incidence: perforation post CC• Locat...
Conclusion   location relates to postoperative hearing results    and the likelihood of residual disease   earlier diagn...
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Congenital Cholesteatoma ESPO Paris

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our experience in primary cholesteatoma surgery presentated at the ESPO Paris

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Transcript of "Congenital Cholesteatoma ESPO Paris"

  1. 1. www.orl-marseille.com Congenital middle ear cholesteatomas in childrenA Abbas, R Nicollas, I Sudre, H Belaïche, S Roman, JM Triglia Dr Ali ABBAS Pediatric ENT department Timone Children Hospital Marseille France 20/06/2006
  2. 2. Why? Problem: early diagnosis Comparative study with acquired cholesteatoma in children Objective: to determine criterias allowing earlier diagnosis
  3. 3. Material and methods Monocentric and comparative prospective study from 1994 to 2005, n = 322 cases of cholesteatoma in children Mean follow-up = 48 months Canal wall up procedureCongenital cholesteatoma Acquired cholesteatoma n=61 n=2614 bilateral cases 14 bilateral casesMean age: 6 years [1,1 to 13,9] Mean age: 10 years [3,4 to 18]Gender: 59% boys gender: 62% boys
  4. 4. Results Clinical n=61 otalgia non symptomaticserous otitis media 13% 9% 31% 24% 23% deafness otorrhea
  5. 5. Results Initial location n=61 anterior superior posterior superior quadrant quadrant 83 % 31 %anterior inferior posterior inferior quadrant quadrant 3% 3%
  6. 6. Surgical results Procedure n=61 limited pattern (anterior superior): 23% exploratorytympanotomy (simple removal, better prognosis) extended pattern (posterior & diffuse): 77% CWUtympanomastoidectomy (2nd look reexploration, ossiculoplasty) Recurrence rate: 20,3% of cases
  7. 7. Comparative study (κ 2 Student) Congenital (n=61) Acquired (n=261)Asymptomatic 31% 8%Deafness 24% 24%Otitis 22% -Otorrhea 23% 80% p<0,05
  8. 8. Anatomical presentation Congenital (n = 61) Acquired (n = 261)“cystic” closed pattern 36% 54%“infiltrate”opened pattern 64% 46%without ossicle lysis 63% 25%incus lysis 64% 68%stapes lysis 40% 31% p<0,05
  9. 9. Contralateral ear Congenital (n=61) Acquired (n=261)Normal 84% 56%SOM 12% 13%Chronic otitis 4% 31% p<0,05
  10. 10. Postoperative hearing assessments Congenital (n=61) Acquired (n=261)Preoperative ABG (dB): 28 [26 à 59] 27 [7 à 56]Postoperative ABG (dB): 15 [0 à 47] 17 [0 à 60]Preoperative mean AC (dB): 38 35 p<0,05
  11. 11. Discussion Levenson’s criterias: – CC children with AOM – under-estimated incidence: perforation post CC• LocationSeries Year Number of Antero-mallear Postero- cases (%) mallear(%)Parisier 1989 40 67,5 15McGill 1991 41 41 0Postic 2002 172 82 49Nelson 2002 119 85,1 77Our study 2006 61 83 31
  12. 12. Conclusion location relates to postoperative hearing results and the likelihood of residual disease earlier diagnosis = better surgical result Large increase in reports of CC

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