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Clinical and diagnostic peculiarities of middle ear cholesteatoma course in children

Presenting Author: Eugene V. Garov

Published online by Cambridge University Press:  03 June 2016

Eugene V. Garov ,
Alexey Ivoylov ,
Andrey I. Kryukov ,
Natalia L. Kunelskaya ,
Eugene V. Garov ,
Valentina R. Pakina  and
Ekaterina E. Garova
Eugene V. Garov
Affiliation:
L.I. Sverzhevski Scientific Research Clinical Institute of Otorhinolaryngology of Moscow Municipal Health Department, Russia
Alexey Ivoylov
Affiliation:
L.I. Sverzhevski Scientific Research Clinical Institute of Otorhinolaryngology of Moscow Municipal Health Department, Russia
Andrey I. Kryukov
Affiliation:
L.I. Sverzhevski Scientific Research Clinical Institute of Otorhinolaryngology of Moscow Municipal Health Department, Russia
Natalia L. Kunelskaya
Affiliation:
L.I. Sverzhevski Scientific Research Clinical Institute of Otorhinolaryngology of Moscow Municipal Health Department, Russia
Eugene V. Garov
Affiliation:
L.I. Sverzhevski Scientific Research Clinical Institute of Otorhinolaryngology of Moscow Municipal Health Department, Russia
Valentina R. Pakina
Affiliation:
L.I. Sverzhevski Scientific Research Clinical Institute of Otorhinolaryngology of Moscow Municipal Health Department, Russia
Ekaterina E. Garova
Affiliation:
L.I. Sverzhevski Scientific Research Clinical Institute of Otorhinolaryngology of Moscow Municipal Health Department, Russia
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Abstract

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Learning Objectives:

Goal: To study clinical and diagnostic peculiarities of middle ear cholesteatoma in children with chronic suppurative otitis media.

Materials and methods: 139 children with chronic suppurative otitis media (CSOM); (3 to 18 years). Collection of anamnesis of life, diseases, complaints, otoendoscopy, CT of temporal bones, audiologic and microbiologic studies.

Results: Chronic tube tympanic suppurative otitis media (CTTSOM) was diagnosed in 90 patients, chronic atticoantral suppurative otitis media (CASOM) was diagnosed in 49. Bilateral process was identified in 20 patients, left sided process was diagnosed on 79 patients and right sided process was diagnosed in 60 patients. Duration of CSOM constituted 3–14 years in 78.5%, it started in age of 1–3 years. At CTTSOM perforation of ear-drum pars tensa occurred in 10(9.7%) patients, and central one occurred in 93(90.3%). At CASOM defect of pars flaccid occurred in 38(63.8%), and subtotal one occurred in 18 (36.2%). Monoflora: St.aureus (27), Ps.aeruginosa (22), St.epidermidis (11), Kl.pneumonia (10), Morganella morganii (7), Str.pyogenes (6), E.coli (5), 33 patients showed mixed flora at CASOM, 25 - didn't show flora growth at CTTSOM. Study of hearing: conductive hearing loss at CTTSOM and mixed form of hearing loss with hearing thresholds by bone conduction constituted 10.0 ± 0.6 dB-20.0 ± 1.8 dB at CASOM, 100% speech discrimination without recruitment. CT-symptoms of middle ear cholesteatoma were diagnosed in 33 patients with CASOM, and in 8 - with CTTSOM. In all cases of follow-up cholesteatoma diagnosis was confirmed with intraoperative findings.

Conclusions: CASOM in children is followed by cholesteatoma development in 67.3% of cases, and CTTSOM is followed by cholesteatoma in 8.9%. Registration of sensorineural component, 100% speech discrimination, and absence of recruitment indirectly indicate to cholesteatoma process in ear. CT of temporal bones is a “golden standard” in diagnostics of ear cholesteatoma.