Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University Hospital, Cheonan, South Korea.
Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
JAMA Otolaryngol Head Neck Surg. 2023 Mar 1;149(3):231-238. doi: 10.1001/jamaoto.2022.4660.
Transcanal endoscopic ear surgery (TEES) provides minimally invasive transcanal access to the middle ear and improves middle ear visibility during cholesteatoma resection. However, the literature on outcomes following TEES alone for the removal of congenital cholesteatoma (CC) is lacking and limited to small series.
To assess outcomes of TEES for CC limited to the middle ear and/or mastoid antrum and to explore the risk factors associated with recidivism (ie, recurrent and/or residual cholesteatoma).
DESIGN, SETTING, AND PARTICIPANTS: This cohort study evaluated retrospective, multicenter data for 271 children with CC who underwent TEES at 9 tertiary referral hospitals in South Korea between January 1, 2013, and December 31, 2021, and had a follow-up of at least 6 months after surgery.
Outcomes included the incidence of residual cholesteatoma and audiometric data after TEES. A multivariable analysis using Cox proportional hazards regression models was used to assess associations between cholesteatoma characteristics and recidivism, with hazard ratios (HRs) and 95% CIs reported.
Of the 271 patients (mean [SD] age, 3.5 [2.9] years; 194 [71.6%] boys, 77 [28.4%] girls), 190 had Potsic stage I CC (70.1%), 21 (7.7%) had stage II, 57 (21.0%) had stage III, and 3 (1.1%) had stage IV. Thirty-six patients (13.3%) with residual cholesteatoma were found, including 15 (7.9%) with Potsic stage I, 3 (14.3%) with stage II, and 18 (31.6%) with stage III. In the multivariable analysis, invasion of the malleus (HR, 2.257; 95% CI, 1.074-4.743) and posterosuperior quadrant location (HR, 3.078; 95% CI, 1.540-6.151) were associated with the incidence of recidivism. Overall, hearing loss (>25 dB on auditory behavioral test or >30 dB of auditory evoked responses) decreased from 24.4% to 17.7% after TEES.
This cohort study involved the largest known population to date of CC removed by TEES. The findings suggest that TEES may be feasible and effective for the removal of CC limited to the middle ear and/or mastoid antrum in children.
经耳道内镜耳外科（TEES）提供了经耳道的微创通道，可改善胆脂瘤切除过程中的中耳可视性。然而，单独使用 TEES 治疗先天性胆脂瘤（CC）的文献很少，且仅限于小系列研究。
评估 TEES 治疗局限于中耳和/或乳突窦的 CC 的结果，并探讨与复发相关的风险因素（即复发性和/或残留胆脂瘤）。
设计、地点和参与者：本队列研究评估了 2013 年 1 月 1 日至 2021 年 12 月 31 日期间，韩国 9 家三级转诊医院的 271 名 CC 患儿的回顾性多中心数据，这些患儿接受了 TEES 治疗，且术后随访至少 6 个月。
结局包括 TEES 后的残留胆脂瘤发生率和听力数据。使用 Cox 比例风险回归模型进行多变量分析，以评估胆脂瘤特征与复发之间的关联，报告风险比（HR）和 95%置信区间（CI）。
在 271 名患者（平均[标准差]年龄，3.5[2.9]岁；194[71.6%]名男孩，77[28.4%]名女孩）中，190 名患有 Potsic I 期 CC（70.1%），21 名（7.7%）患有 II 期，57 名（21.0%）患有 III 期，3 名（1.1%）患有 IV 期。发现 36 名（13.3%）患者存在残留胆脂瘤，其中 15 名（7.9%）患有 Potsic I 期，3 名（14.3%）患有 II 期，18 名（31.6%）患有 III 期。在多变量分析中，锤骨的侵袭（HR，2.257；95%CI，1.074-4.743）和后上象限的位置（HR，3.078；95%CI，1.540-6.151）与复发的发生率相关。总体而言，TEES 后听力损失（听觉行为测试>25 dB 或听觉诱发电位>30 dB）从 24.4%下降至 17.7%。
本队列研究涉及迄今为止已知的最大的 CC 经 TEES 切除人群。研究结果表明，TEES 可能适用于治疗儿童局限于中耳和/或乳突窦的 CC。
