Outcomes of Treatment of Cholesteatoma with Canal Up Technique in Pediatric Patients
SHAN Liang
CHEN Wenwen
TONG Jun
DAENG Yaxin
CAI Xunhua
DU Lijun
Abstract： Objective To report results of treatment of otitis media with cholesteatoma using the canal-up technique in pediat-ric patients. Methods Twenty five patients (18 boys and 7 girls, mean age=15.74±3.97 years ranging from 4 to 19 years)were in-cluded. Average follow up was 6.75±38.32 months (12-132 months). Thirteen patients received only one operation. Revision pro-cedures were performed in 12 patients (mean revision procedures=3), resulting in a total of 49 procedures. In 6 cases, the first oper-ation was performed in our hospital 8-16 years ago. Canal down technique was used in 4 of the 6 cases and canal up technique was used in,2 cases. Revision was needed,due to residual diseases including perforation of tympanic membrane, tympanic cavity effu-sion, and recurrence of cholesteatoma. Of the 19 cases in which the first operation was performed in our hospital, 8 presented with 1-12 months history of purulent drainage, 3 with pars tensa perforation, 15 with pars flaccida pockets or granulation, and 1 with in- tact tympanic membrane but conductive deafness. Canal down technique was used in the other 6 cases whose primary operation was performed by other hospitals, all with recurrence of cholesteatoma. Pre-operative average air-bone gap (GAP) over 0.5-2 kHz was 37.16±15.52 dB HL in 25 cases and mean air and bone conduction (AC and BC)thresholds were 46.45±17.45 dB HL and 9.45±6.12 dB HL respectively. Surgical treatments included eradication of cholesteatoma using a canal-up technique, with the bony bridge or posterior canal wall preserved. The mucosa in mastoid cavity was preserved for possible re-pneumatization. The tympani corda was preserved to support the POPE or TOPE. A tube was left in place in cases with pre-operative tympani cavity effusion. The U test was used in outcomes assessment. Results Drum perforation, effusion and recurrent cholesteatoma were seen during revision in the 6 cases originally operated in our hospital, with cholesteatoma pockets and bone erosion. The recurrent rate was 31%(6/19), com-pared to 13%(2/15) when the cananl up technique was used. There was no recurrence durng the 12 months or longer followed up af-ter revision. In the 25 cases, post-operative mean GAP (15.95±12.99 dB HL) showed improvement compared with pre-operative GAP, (U=5.13>u0.01=2.57,P<0.01):while the mean post-operative AC(28.41±14.43 dB HL) also showed improvement compared with pre-operative AC (U=3.90>u0.01=2.57,P<0.01). There was no change in post-operative BC(10.83±10.97dB HL,U=0.53). Postoperative GAP was less than 20 dB in 20 cases. While it was>20 dB in 3 cases, their AC was less than 40 dB HL. Treatment was considered successful in 23 cases (92%), with. GAP at 10 dB or less in 10 cases (40%) and mean GAP at 20.45±14.29 dB for the 25 cases. Post-operative CT scans at 3-9 years in 3 case indicated no recurrent cholesteatoma. Post-GAP (10.61±9.28 dB) after the primary procedures in13 cases (52%) was better than that (22.27±14.27 dB) after revision procedures in 12 cases (U=2.23>u0.05=1.96, P<0.05). Conclusion Although treatment with canal up technique for cholesteatoma does not completely prevent recurrence in pediatric patients (about 13%), revision with the same canal up technique may still yield good results while reducing future recur-rence,andotherproblemsassociatedwiththecanal-down techniqueandpreservinggoodhearingandearcanalanatomy.
Keywords：Juvenile and Childrenotitismediacholesteatomatympanoplastyhaering reconstructioncanal-upcanal-down
Publication Date：2013-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 263-266 )