De Corso Eugenio, Marchese Maria Raffaella, Scarano Emanuele, Paludetti Gaetano
Department of Otorhinolaryngology, Catholic University of Sacred Heart, Rome, Italy.
Int J Pediatr Otorhinolaryngol. 2006 Jul;70(7):1269-73. doi: 10.1016/j.ijporl.2006.01.006. Epub 2006 Feb 20.
This study was designed to compare clinical features, surgical findings and treatment results from children and adults affected by aural acquired cholesteatoma.
a retrospective review of 60 children (Group I: mean age 8.8 years, range 3-16 years) and 308 adults (Group II: mean age 45.4 years, range 18-81 years) with aural acquired cholesteatoma who underwent surgery from January 1992 to December 2002, was performed with a follow-up of 5 years. All patients were submitted to single-staged canal wall down tympanoplasty. Variables analysed were otoscopic features, extent of cholesteatoma, surgical findings and the rate of recidivism.
The pathologic changes in the tympanic membrane were no different in the two groups. According to Stangerup et al. 40 cases (66.6%) of children were classified as stage III or more, with a significant higher incidence compared to adults (152 cases; 49.3%). Analysis of the ossicular chain state showed, in group I, a significant higher incidence of eroded or absent incus (76.6% versus 61.68%) and malleus (76.6% versus 56.48%), if compared to adults. Children, therefore, had a significantly higher risk of recurrence with a rate of 26.6% in Group I and 6.81% in group II. After surgery the mean gain measured in children group, was 11 dB and 13 dB in adults.
In our study we found that the behaviour of cholesteatoma in children appears more aggressive than in adults. In fact, we found a greater extension of the cholesteatoma, a worse state of the ossicular chain and a higher incidence of recurrence. Therefore, we obtained acceptable hearing results both in children and in adults.
本研究旨在比较儿童和成人获得性中耳胆脂瘤的临床特征、手术所见及治疗结果。
对1992年1月至2002年12月间接受手术的60例儿童（第一组：平均年龄8.8岁，范围3 - 16岁）和308例成人（第二组：平均年龄45.4岁，范围18 - 81岁）获得性中耳胆脂瘤患者进行回顾性研究，随访5年。所有患者均接受一期开放式鼓室成形术。分析的变量包括耳镜特征、胆脂瘤范围、手术所见及复发率。
两组鼓膜的病理改变无差异。根据Stangerup等人的标准，40例（66.6%）儿童被归类为III期或更高级别，其发生率显著高于成人（152例；49.3%）。听骨链状态分析显示，与成人相比，第一组儿童砧骨侵蚀或缺失（76.6%对61.68%）和锤骨（76.6%对56.48%）的发生率显著更高。因此，儿童复发风险显著更高，第一组复发率为26.6%，第二组为6.81%。手术后，儿童组平均听力增益为11dB，成人组为13dB。
在我们的研究中，我们发现儿童胆脂瘤的行为似乎比成人更具侵袭性。事实上，我们发现胆脂瘤范围更大、听骨链状态更差且复发率更高。因此，我们在儿童和成人中均获得了可接受的听力结果。
