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Review
. 2020 Mar;15(1):17-26.
doi: 10.1016/j.joto.2018.11.009. Epub 2018 Dec 3.

Endoscopic Management of Pediatric Cholesteatoma

Peter J Ryan  1 , Nirmal P Patel  1   2
Affiliations
Review

Endoscopic Management of Pediatric Cholesteatoma

Peter J Ryan et al. J Otol. 2020 Mar.

Erratum in

Abstract

Pediatric cholesteatoma occurs in one of two forms: congenital cholesteatoma, developing from embryonic epidermal cell rests or acquired cholesteatoma, associated with a focal defect in the tympanic membrane. This disease has been traditionally managed with the operating microscope, often requiring mastoidectomy for adequate visualization of and access to the middle ear and mastoid cavities. Recently, advances in endoscopic equipment have enabled otologists to manage most cases of pediatric cholesteatoma via a minimally-invasive, transcanal endoscopic approach. This review discusses the current literature relating to the etiopathogenesis, assessment and endoscopic management of pediatric cholesteatoma. Early outcomes of endoscopic treatment, emerging trends and technologies are also reviewed.

Keywords: Cholesteatoma; Endoscopic; Mastoid; Middle ear; Minimally-invasive; Pediatric.

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Figures

Fig. 1
Fig. 1
Atypical otoscopic findings in open type congenital cholesteatoma may be mistaken for acquired cholesteatoma in a 10-year-old, right ear.
Fig. 2
Fig. 2
Otoscopic view of a CTCC in a 2-year-old, right ear.
Fig. 3
Fig. 3
Operative findings of the CTCC in the same 2-year-old shown in Fig. 2.
Fig. 4
Fig. 4
Otoscopic view of an OTCC in a 12-year-old, left ear.
Fig. 5
Fig. 5
Operative findings of the OTCC in the same 12-year-old shown in Fig. 4.
Fig. 6
Fig. 6
Acquired pediatric cholesteatoma resulting from a focal defect in the tympanic membrane in a 5-year-old, right ear.
Fig. 7
Fig. 7
Angled scope view of attic cholesteatoma sac in a right ear, exemplifying the wide viewing angle of modern endoscopes in a 12-year-old.
Fig. 8
Fig. 8
Narrow left ear canal with angled beaver tympanoplasty blade demonstrating the limitation a narrow canal can place on the view and passage of instruments in a 3-year-old, left ear.
Fig. 9
Fig. 9
Straight beaver tympanoplasty blade permitted more easily in the same narrow canal as Fig. 8.
Fig. 10
Fig. 10
Axial CT image of a left CTCC in a 5-year-old.
Fig. 11
Fig. 11
Contralateral view of retrotympanum after resection in an 8-year-old, right ear.
Fig. 12
Fig. 12
Protympanum: cholesteatoma in subtensor space and over protiniculum in a 10-year-old, right ear.
Fig. 13
Fig. 13
Protympanum: clearing the subtensor recess in a 10-year-old, right ear.
Fig. 14
Fig. 14
Dissection of CTCC off the handle of malleus in a 2-year-old, right ear.
Fig. 15
Fig. 15
Thin tragal cartilage graft used in reconstruction in a 3-year-old.
Fig. 16
Fig. 16
Otoscopic view of a right post-operative attic and tympanum reconstruction (at 8 weeks), 12-year-old.
Fig. 17
Fig. 17
KTP laser in use over the stapedius tendon during EES for pediatric cholesteatoma in a 6-year-old, left ear.
See this image and copyright information in PMC

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