Miller Katherine M, Liu Yi-Chun Carol, Weinstein Jaqueline E, Cohen Michael S, Chi David H, Anne Samantha
Department of Pediatric Otolaryngology, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, USA.
Otolaryngol Head Neck Surg. 2025 Jan;172(1):299-306. doi: 10.1002/ohn.1025. Epub 2024 Oct 23.
The objective of the study is to evaluate the outcomes of surgical management options for cholesteatoma using a national database.
Database analysis of the Pediatric Health Information System database to identify children undergoing surgical intervention for cholesteatoma from October 2015 to December 2022.
Patients were categorized by initial surgical modality: tympanoplasty (TM), tympanoplasty with canal wall-up tympanomastoidectomy (TM-CWU), and tympanoplasty with canal wall-down tympanomastoidectomy (TM-CWD). Group comparisons were done on number of surgical revisions and number of patients identified with recommendations for hearing aids.
A total of 6304 patients were identified in the database who underwent surgery for cholesteatoma. Of these children, 3405 underwent TM (54.0%), 3116 underwent TM-CWU (49.4%), and 825 underwent TM-CWD (8.2%). The estimated difference in mean number of procedures was significantly higher in the TM-CWU group compared to TM-CWD (-0.34, 95% confidence interval [CI] -0.406,-0.279, P < .0001) and the TM group (9.352, 95% CI 0.315, 0.390, P < .0001). The rate of significant hearing loss necessitating hearing aids was significantly lower in the TM group, but there was no difference between the TM-CWU and TM-CWD groups (1.2%, P < .03, 1.9% vs 2.7%, P = .13). There was no difference in the number of speech delays/therapy diagnoses between TM and TM-CWU or TM-CWU and TM-CWD (3.5%vs 4.4% P = .07, 4.4% vs 5.2%., P = .38).
TM and TM-CWD had lower total surgical procedures than the TM-CWU group, and the TM group had a lesser rate of recommendation for hearing aids. The difference between number of procedures is likely due to the complexity of the disease; for instance, TM was likely chosen for small, less severe disease cases, whereas TM-CWD was chosen as more definitive treatment in aggressive cases. TM-CWD is associated with a lower rate of recidivism and recurrence, which also likely contributed to the lower number of procedures.
本研究的目的是利用一个全国性数据库评估胆脂瘤手术治疗方案的效果。
对儿科健康信息系统数据库进行数据分析，以确定2015年10月至2022年12月期间接受胆脂瘤手术干预的儿童。
根据初始手术方式对患者进行分类：鼓室成形术（TM）、外耳道上壁鼓室乳突切除术鼓室成形术（TM-CWU）和外耳道下壁鼓室乳突切除术鼓室成形术（TM-CWD）。对手术翻修次数和确定需要助听器建议的患者人数进行组间比较。
数据库中共有6304例接受胆脂瘤手术的患者。在这些儿童中，3405例接受了TM手术（54.0%），3116例接受了TM-CWU手术（49.4%），825例接受了TM-CWD手术（8.2%）。与TM-CWD组（-0.34，95%置信区间[CI]-0.406，-0.279，P < .0001）和TM组（9.352，95%CI 0.315，0.390，P < .0001）相比，TM-CWU组的平均手术次数估计差异显著更高。TM组中因严重听力损失而需要助听器的比例显著较低，但TM-CWU组和TM-CWD组之间没有差异（1.2%，P < .03，1.9%对2.7%，P = .13）。TM组与TM-CWU组之间或TM-CWU组与TM-CWD组之间在言语延迟/治疗诊断数量上没有差异（3.5%对4.4%，P = .07，4.4%对5.2%，P = .38）。
TM和TM-CWD组的总手术次数低于TM-CWU组，且TM组需要助听器建议的比例较低。手术次数的差异可能是由于疾病的复杂性；例如，TM可能用于较小、病情较轻的病例，而TM-CWD则被选为侵袭性病例的更确定性治疗方法。TM-CWD与较低的复发率相关，这也可能导致手术次数较少。
