Morita Yuka, Yamamoto Yutaka, Oshima Shinsuke, Takahashi Kuniyuki, Takahashi Sugata
Department of Otolaryngology-Head and Neck surgery, Faculty of Medicine, Niigata University, Japan.
Department of Otolaryngology-Head and Neck surgery, Faculty of Medicine, Niigata University, Japan.
Auris Nasus Larynx. 2014 Oct;41(5):417-21. doi: 10.1016/j.anl.2014.05.002. Epub 2014 Jun 2.
In general, cholesteatoma tends to recur more frequently in children than in adults. This has been suggested to be due to immature Eustachian tube function, underdeveloped mastoid air cells, and subsequent repetitive otitis media in children. This study was undertaken to determine the characteristics of acquired cholesteatoma in children by comparison with that in adults.
We retrospectively evaluated 42 children with acquired cholesteatoma (males, 38; females, 4; age range, 3-15 years) using medical records from January 1999 to December 2009 at the Department of Otolaryngology, Niigata University Hospital. The extent of disease was classified according to the Classification and Staging of cholesteatoma proposed by the Japan Otological Society in 2010.
No major differences in stage classification were observed between children and adults. In children with pars flaccida-type cholesteatoma, the epithelium tended to invade from the attic to the mastoid cavity and mesotympanum. In contrast, adult patients with invasion to the mesotympanum were fewer. The rate of disappearance of the stapes superstructure was almost the same in children and in adults. The destruction of the superstructure of the stapes was more common in pars tensa type than pars flaccida type; so it was dependent on the pathology. Postoperative hearing levels were better in children, even in those with widespread lesions. However, the recurrence rate was significantly higher in children.
Acquired cholesteatoma in children showed a wider invasion, and the recurrence rates were higher than that in adults. For patients with a widespread lesion and severe destruction of the ossicles, a two-stage surgery is recommended.
一般来说，胆脂瘤在儿童中比在成人中更容易复发。这被认为是由于儿童咽鼓管功能不成熟、乳突气房发育不全以及随后反复发生中耳炎所致。本研究旨在通过与成人获得性胆脂瘤进行比较，确定儿童获得性胆脂瘤的特征。
我们回顾性评估了1999年1月至2009年12月在新潟大学医院耳鼻喉科就诊的42例获得性胆脂瘤患儿（男38例，女4例；年龄范围3 - 15岁）。疾病范围根据日本耳科学会2010年提出的胆脂瘤分类和分期进行分类。
儿童和成人在分期分类上未观察到重大差异。在松弛部型胆脂瘤患儿中，上皮组织倾向于从鼓室上隐窝侵入乳突腔和中耳腔。相比之下，侵入中耳腔的成年患者较少。儿童和成人镫骨上部结构消失的发生率几乎相同。镫骨上部结构的破坏在紧张部型比松弛部型更常见；因此它取决于病理类型。儿童术后听力水平更好，即使是那些病变广泛的患儿。然而，儿童的复发率明显更高。
儿童获得性胆脂瘤显示出更广泛的侵袭，且复发率高于成人。对于病变广泛且听小骨严重破坏的患者，建议进行两阶段手术。
