Triglia J M, Gillot J C, Giovanni A, Cannoni M
Département d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Hôpital de la Timone, Marseille.
Ann Otolaryngol Chir Cervicofac. 1993;110(8):437-43.
Cholesteatoma occurs in 10% of cases of chronic otitis in children. In most children, the clinical form is very similar to acquired cholesteatoma in the adult. However, we observed certain clinical variations in our retrospective series of 80 cases seen in our unit over the past 8 years. In most all cases, otorrhoea and hypoacousia were the presenting signs. The tympanic membrane was fully intact in 10% of the cases raising the possibility of congenital pathogenesis. An analysis of the correlations between per-operative observations and tomodensitometric results was conducted. Closed tympanoplasty, with a second operation 11 months later, was performed in 84% of the cases. Residual cholesteatoma was observed in 41% of the second operations and relapse occurred in 16%. These anatomic and functional findings, compared with those in the literature, demonstrate that no major difference in the published series. Presently the most important point is to separate acquired and congenital forms, which differ in terms of pathogenesis and clinical presentation, but are treated in the same manner. Progress in the treatment of cholesteatoma of the middle ear in children will come from prevention through earlier diagnosis of pathological manifestations in the ear nose and throat, in particular blocked Eustachian tubes, and through follow-up and treatment of pre-cholesteatomous states, as well as further advances in fundamental research.
胆脂瘤在儿童慢性中耳炎病例中占10%。在大多数儿童中，其临床症状与成人后天性胆脂瘤非常相似。然而，在我们过去8年里回顾的80例病例中，我们观察到了一些临床差异。在几乎所有病例中，耳漏和听力减退是主要症状。10%的病例鼓膜完全完整，这增加了先天性发病机制的可能性。我们对术中观察结果与计算机断层扫描结果之间的相关性进行了分析。84%的病例进行了一期鼓膜成形术，并在11个月后进行了二期手术。在二期手术中，41%的病例观察到残留胆脂瘤，16%的病例复发。与文献中的解剖学和功能学研究结果相比，这些结果表明已发表的系列研究中没有重大差异。目前最重要的一点是区分后天性和先天性胆脂瘤，它们在发病机制和临床表现上有所不同，但治疗方式相同。儿童中耳胆脂瘤治疗的进展将来自于通过早期诊断耳鼻喉科的病理表现（特别是咽鼓管堵塞）进行预防，以及对胆脂瘤前期状态的随访和治疗，还有基础研究的进一步发展。
