Sun Wan-Hsuan, Kuo Chin-Lung, Huang Tzu-Chin
Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan.
Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taiwan.
Int J Pediatr Otorhinolaryngol. 2018 Feb;105:118-122. doi: 10.1016/j.ijporl.2017.12.016. Epub 2017 Dec 15.
The feasibility of TEES in dealing with pediatric middle ear disease is still under investigation. The goal of this study was to compare anatomical dimensions of the EAC between children and adults, and to analyze the anatomic applicability of TEES in children.
Forty pediatric (18 years old and younger) and 20 adult patients who received TB-HRCT to evaluate middle ear conditions were enrolled from December 2010 to December 2015. Dimensions including the diameters of the EAC orifice, isthmus and tympanic membrane annulus, the length of EAC, the height of the middle ear, and the angle between tympanic membrane and EAC axis were determined according to the TB-HRCT data.
The diameters of the EAC orifice and isthmus and length of EAC in the pediatric patients were slightly smaller than those in the adult patients. The anatomical dimensions of middle ear were similar in both groups. Simple regression analysis indicated that the diameters of the EAC orifice and isthmus and the length of the EAC were positively correlated with the age of the pediatric patients. In the pediatric patients, 67 ears (83.75%) had an EAC isthmus diameter larger than 4 mm and are sufficient with a 3-mm endoscope manipulation.
TEES is applicable for most pediatric patients using an endoscope with a diameter of 3 mm or smaller. With an appropriate endoscope and instruments, TEES is a safe and effective alternative to treat pediatric middle ear disease.
经外耳道耳内镜手术（TEES）治疗小儿中耳疾病的可行性仍在研究中。本研究的目的是比较儿童和成人外耳道（EAC）的解剖学尺寸，并分析TEES在儿童中的解剖学适用性。
选取2010年12月至2015年12月期间接受颞骨高分辨率CT（TB-HRCT）以评估中耳情况的40例18岁及以下儿童患者和20例成人患者。根据TB-HRCT数据确定包括EAC开口、峡部和鼓膜环的直径、EAC的长度、中耳的高度以及鼓膜与EAC轴之间的角度等尺寸。
儿童患者的EAC开口和峡部直径以及EAC长度略小于成人患者。两组中耳的解剖学尺寸相似。简单回归分析表明，EAC开口和峡部直径以及EAC长度与儿童患者的年龄呈正相关。在儿童患者中，67只耳朵（83.75%）的EAC峡部直径大于4毫米，使用3毫米的内镜操作足够。
使用直径为3毫米或更小的内镜，TEES适用于大多数儿童患者。配备合适的内镜和器械，TEES是治疗小儿中耳疾病的一种安全有效的替代方法。
