Key Points
QuestionFor congenital cholesteatoma (CC) limited to the middle ear and/or mastoid antrum in children, is the use of total transcanal endoscopic resection associated with a reduced risk of residual cholesteatoma?
FindingsIn this cohort study of 271 children with CC limited to the middle ear and/or mastoid antrum, the incidence of residual cholesteatoma after transcanal endoscopic ear surgery was 13.3%, with a favorable surgical outcome.
MeaningThis study’s findings suggest that transcanal endoscopic ear surgery may be an effective alternative for children with CC limited to the middle ear and/or mastoid antrum.
ImportanceTranscanal 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.
Objective评估的结果为CC有限的m t恤iddle ear and/or mastoid antrum and to explore the risk factors associated with recidivism (ie, recurrent and/or residual cholesteatoma).
Design, Setting, and ParticipantsThis 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.
Main Outcomes and MeasuresOutcomes 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.
ResultsOf 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.
Conclusions and RelevanceThis 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.