Pediatric tympanic membrane cholesteatoma: Systematic review and meta-analysis

Document Type

Conference Proceeding

Publication Date

1-1-2017

Publication Title

International Journal of Pediatric Otorhinolaryngology

Publisher

Elsevier Ireland Ltd

Volume

102

First page number:

21

Last page number:

27

Abstract

Introduction Tympanic membrane cholesteatoma (TMC) is a rare anomaly found in pediatric patients with no significant otologic history. Its pathogenesis appears distinct from congenital mesotympanic cholesteatoma. This systematic review and meta-analysis evaluates the management of TMC. Methods Two authors independently conducted a systematic review using the PubMed-NCBI, Cochrane Library, and Web of Science databases. Studies describing cases of pediatric TMC were included. Patients with history of chronic otitis, otorrhea, trauma, or otologic surgery were excluded. Results Seventeen articles were included for a total of 45 patients. Mean age was 35.9 months with 56% female. Patients aged ≥36 months had significantly larger cholesteatomas than younger patients (4.2 vs 1.9 mm, p = 0.004). Nine patients (20%) had middle ear extension but none had middle ear or ossicular disease. CT scans influenced management in 1 of 26 patients. All patients were managed surgically by transcanal approach (93%) or retroauricular approach (7%). Surgery involved enucleation without TM perforation (80%) or complete excision with TM grafting (20%). In 23 patients, the fibrous TM remained intact, and there were no recurrences in this group at a mean follow-up of 11 months. Overall, there was 1 recurrence (2%), eventually requiring reoperation. No patients experienced persistent tympanic membrane perforation, chronic otitis, or hearing loss. Conclusion TMC occurs in pediatric patients without an otologic history. Associated middle ear involvement has not been reported. CT scanning may not be necessary for work up and management of this disorder. A transcanal approach with enucleation is often sufficient treatment. Risk of recurrence appears lower than with congenital mesotympanic cholesteatoma. © 2017 Elsevier B.V.

Language

english

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