Fontes Lima António, Carvalho Moreira Filipa, Sousa Menezes Ana, Esteves Costa Isabel, Azevedo Cátia, Sá Breda Miguel, Dias Luís
Department of Otorhinolaryngology, Hospital de Braga, 4715, Braga, Portugal.
Department of Otorhinolaryngology, Hospital de Braga, 4715, Braga, Portugal.
Int J Pediatr Otorhinolaryngol. 2020 Nov;138:110170. doi: 10.1016/j.ijporl.2020.110170. Epub 2020 Jul 16.
chronic otitis media with cholesteatoma (COMC) is a serious condition that may cause severe complications. According to the literature, in pediatric patients this entity can have a more aggressive behavior, leading to higher rates of morbidity. Consensus regarding the definition of aggressive and extensive cholesteatoma was lacking until recently. European Academy of Otology and Neurotology/Japan Otologic Society (EAONO/JOS) proposed a classification and staging system which was highly accepted by a group of otology experts.
to compare cholesteatoma characteristics between pediatric and adult patients using the EAONO/JOS stating system.
a retrospective analysis of the patients who underwent surgery for cholesteatoma treatment in a tertiary hospital was performed using EAONO/JOS classification. Congenital cholesteatoma, revision surgery, and follow-up losses were excluded. The patients were further divided into two cohorts: a pediatric group (<16 years old) and an adult group (>16 years old). The results were compared between them.
134 patients fulfilled the inclusion criteria, 27 were pediatric, and 107 adult patients. We found a significant difference in supratubal recess, with higher rates of extension to this location in the pediatric group. Also in the pediatric cohort, COMC was accompanied by malleus erosion in a higher frequency, with a significant difference from adults; it also presented in higher stages of the disease according to EAONO/JOS classification. We found no differences in hearing gain post-operatively. Moreover, we found that age younger than 16 years was an independent risk factor for relapse with time.
according to our data, cholesteatoma in pediatric age has a more aggressive and extensive nature than in adults, and age younger than 16-years-old is an independent risk factor for relapse.
慢性化脓性中耳炎伴胆脂瘤（COMC）是一种严重疾病，可能导致严重并发症。根据文献，在儿科患者中，这种疾病可能具有更具侵袭性的行为，导致更高的发病率。直到最近，关于侵袭性和广泛性胆脂瘤的定义仍缺乏共识。欧洲耳科学与神经耳科学学会/日本耳科学会（EAONO/JOS）提出了一种分类和分期系统，该系统得到了一群耳科专家的高度认可。
使用EAONO/JOS分期系统比较儿科和成人患者的胆脂瘤特征。
采用EAONO/JOS分类法对一家三级医院接受胆脂瘤治疗手术的患者进行回顾性分析。排除先天性胆脂瘤、再次手术和失访病例。患者进一步分为两个队列：儿科组（<16岁）和成人组（>16岁）。比较两组结果。
134例患者符合纳入标准，其中儿科患者27例，成人患者107例。我们发现咽鼓管上隐窝存在显著差异，儿科组延伸至该部位的发生率更高。同样在儿科队列中，COMC伴有锤骨侵蚀的频率更高，与成人有显著差异；根据EAONO/JOS分类，其疾病分期也更高。我们发现术后听力增益无差异。此外，我们发现16岁以下是复发的独立危险因素。
根据我们的数据，儿科胆脂瘤比成人胆脂瘤具有更具侵袭性和广泛性，16岁以下是复发的独立危险因素。
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