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Comparative study on adhesive otitis media and pars tensa cholesteatoma in children
Saeko Yoshida1, Saori Seki1, Tomonori Sugiyama1
1Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan.
Insights
Children with adhesive otitis media require careful follow-up. Risk factors like poor mastoid development, middle ear effusion, total adhesion, and otorrhea indicate progression to pars tensa cholesteatoma.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Surgical Otology
Background:
- Recurrent otitis media and otitis media with effusion can lead to atelectatic eardrum and adhesive otitis media in children.
- These conditions may progress to pars tensa cholesteatoma, a serious middle ear disease.
- Optimal surgical timing and management for adhesive otitis media remain debated.
Purpose of the Study:
- To analyze clinical characteristics of children with adhesive otitis media and pars tensa cholesteatoma.
- To identify risk factors associated with the progression from adhesive otitis media to pars tensa cholesteatoma.
Main Methods:
- Retrospective study of 15 children (17 ears) with adhesive otitis media and 13 children (14 ears) with pars tensa cholesteatoma who underwent tympanoplasty.
- Analysis of medical history, associated diseases, adhesion sites, and mastoid air cell development/aeration via temporal bone CT scans.
Main Results:
- Both groups frequently had a history of recurrent or persistent otitis media with effusion, showed male predominance, and associated allergic rhinitis.
- Undeveloped mastoid air cells were significantly more common in the pars tensa cholesteatoma group (P=0.0068).
- Poor middle ear aeration, including the Eustachian tube, was more frequent in pars tensa cholesteatoma (P=0.0012). Otorrhea, total adhesion, and undeveloped mastoid cells were significant risk factors for cholesteatoma.
Conclusions:
- Children with adhesive otitis media need close outpatient monitoring.
- Poor mastoid development is a risk factor for developing pars tensa cholesteatoma.
- Intervention, such as tympanoplasty or tympanostomy tube insertion, should be considered for children with adhesive otitis media exhibiting risk factors to prevent cholesteatoma progression.
Objective:
Recurrent otitis media and persistent otitis media with effusion in early childhood may cause an atelectatic eardrum and adhesive otitis media, which sometimes progress to pars tensa cholesteatoma. When and how children with adhesive otitis media should be operated on remain controversial. Therefore, this study aimed to analyze the clinical characteristics of children with adhesive otitis media and pars tensa cholesteatoma, and to determine the risk factors of progression to cholesteatoma.
Methods:
Seventeen ears of 15 children with adhesive otitis media (adhesive group) and 14 ears of 13 children with pars tensa cholesteatoma (tensa cholesteatoma group) who underwent tympanoplasty were included in this study. We analyzed the following clinical characteristics of children in both groups: medical and life history, associated diseases, sites of the adhesion, and development and aeration of mastoid air cells as shown by temporal bone computed tomography.
Results:
Most of the children in both groups had a history of recurrent otitis media and/or persistent otitis media with effusion. They showed a male predominance and a frequent association of allergic rhinitis. The number of ears showing undeveloped mastoid air cells in the tensa cholesteatoma group was significantly larger than that in the adhesive otitis media group (P=0.0068). A lack of aeration of the middle ear, including the eustachian tube, was more frequently found in ears with pars tensa cholesteatoma than in ears with adhesive otitis media (P=0.0012). Using multivariate logistic regression, the presence of otorrhea (odds ratio [OR], 14.847; 95% confidence interval [CI], 0.834-264.184), total adhesion (OR, 28.550; 95% CI, 0.962-847.508), and undeveloped mastoid air cells (OR, 19.357; 95% CI, 1.022-366.589) were related to pars tensa cholesteatoma.
Conclusion:
Children with adhesive otitis media should be carefully followed up in the outpatient setting. Ears with poor mastoid development may develop pars tensa cholesteatoma. Additionally, ears with middle ear effusion, total adhesion, and the presence of otorrhea tend to be at risk of pars tensa cholesteatoma. Tympanoplasty or tympanostomy tube insertion should be considered for children with adhesive otitis media who have these risk factors to prevent progression to pars tensa cholesteatoma.
