Diseases of the middle ear in childhood

Abstract

Middle ear diseases in childhood play an important role in daily ENT practice due to their high incidence. Some of these like acute otitis media or otitis media with effusion have been studied extensively within the last decades. In this article, we present a selection of important childhood middle ear diseases and discuss the actual literature concerning their treatment, management of complications and outcome. Another main topic of this paper deals with the possibilities of surgical hearing rehabilitation in childhood. The bone-anchored hearing aid BAHA(®) and the active partially implantable device Vibrant Soundbridge(®) could successfully be applied for children. In this manuscript, we discuss the actual literature concerning clinical outcomes of these implantable hearing aids.

Keywords: children; cholesteatoma; implantable hearing aids; mastoiditis; otitis media.

Table 1. Predisposing factors of acute otitis media [1, 5, 8–13]

Table 2. Relevance of clinical symptoms and diagnostic aids in diagnosis of acute otitis media (modified from [12])

Table 3. Spectrum of pathogens in children’s acute otitis media [12, 14, 19–22]

Table 4. Selected studies on acute mastoiditis and its complication in children (SPA: subperiosteal abscess; FP: facial palsy; SST: sinus sigmoideus thrombosis)

Table 5. Current studies on effectiveness of surgical management for OME (AT: adenoidectomy; PC: paracentesis; VT: ventilation tube; WW: watchful waiting)

Table 6. Selected studies concerning functional results after tympanoplasty in childhood (Gr.: Group; VT: Ventilation tube)

Table 7. Classification of epitympanic retraction pockets (after Tos and Poulsen [136])

Table 8. Selected important factors for surgical indication of retracted pockets (modified after [138])

Table 9. Selected studies on functional results after cholesteatoma surgery in childhood (CWD: canal wall down; CWU: canal wall up; IOM: inside-out mastoidectomy)

Table 10. Holgers classification of skin reaction (around the abutment) after BAHA^® implantation [181]

Figure 1. Figure 1a: Central defect of the ear drum on a right ear in a 14-year-old child with tympanosclerosis at the anterior portion (*); b: Intraoperative removal of plaques from the eardrum; c: Reconstruction of the eardrum in underlay technique with cartilage-perichondrium-transplant

Figure 2. Advanced retraction pocket (Type III after Poulsen and Tos) of the right ear

Figure 3. Figure 3a: Congenital cholesteatoma of the right ear in a 5-year-old child; b: Intraoperative situs showing a cholesteatom pearl anterior of the malleus

Figure 4. Figure 4a: Aquired epitampanic cholesteatom on the left side in a 16-year-old child (C: Chorda tympani; +: Incus); b: Removal of cholesteatoma with the inside-out mastoidectomy technique through partial removal of the posterior ear canal; c: Condition after total removal with preservation of the ossicles

Figure 5. Figure 5a: Vibrant Soundbridge^® Coupler for the ovale window; condition after creation of an open cavity left (yellow arrow: N. facialis; #: open cavity with intact horizontal semicircular canal); b: Attachement of the couplers with the Floating Mass Transducer (FMT); c: Placement of the FMT on the footplate