SURGICAL TREATMENT OF CLOSED CHOLESTEATOMA IN CHILDREN USING ENDOSCOPY

Berezniuk I. V.

PATHOMORPHOLOGY

Scentific article

Chronic purulent otitis media (CPOM) is a disease that ENT doctors often have to deal with in their daily practice. However, to date, complete rehabilitation of the middle ear affected by cholesteatoma remains a difficult surgical task. Our goal is to select the optimal surgical treatment for chronic otitis media with cholesteatoma in children. Different variants of tympanoplasty in childhood cause lively discussions among otosurgeons. At the same time, the use of relatively new technologies of microsurgical interventions using an endoscope in children is an insufficiently studied problem. The analysis of different variants of operations on the closed type cholesteatomic otitises with the use of combined endoscopic and microsurgical equipment was carried out. We operated on 65 children (65 ears) with cholesteatoma chronic otitis, aged from 2 to 12 years (mean age – 8.0±0.9 years). The anamnesis, otoscopy, otomycoscopy and endoscopy of the ear, condition of the nose and nasopharynx, pharyngeal opening of the auditory tube, audiological symptoms, location of perforation, presence and nature of secretions, as well as data of intraoperative findings were studied. According to our data the first symptoms of cholesteatoma are otorrhea and hearing loss, which were observed in 45 (69.2%) and 38 (58.5%) cases, respectively. Marginal perforation was observed in 58 (89.2%) patients, retraction – with the presence of purulent exudate with ichorous odor – in 32 (49.2%) cases. Retraction was detected in 25 children, epitympanoma in 33 children and congenital cholesteatoma cholesteatoma in 7 children. Standard closed microsurgery (SCM) by oral access was performed in 33 patients, combined closed microsurgery (CCM) using a microscope and endoscope was performed in 32 children (including endoscopically endaurally – 10 children). The results showed that surgical treatment of children with cholesteatoma should be performed to minimize the risk of recurrence and preference should be given to closed versions of tympanoplasty using an endoscope or a combined technique with a microscope and endoscope. The use of an endoscope or microscope in otoscopy significantly increases the detection of cholesteatoma in children from 2 years old, while the lack of optics leads to a later confirmation of the diagnosis – from 6-7 years and older. The use of an endoscope during surgery with or without a microscope improves the visualization and diagnosis of cholesteatoma in hard-to-reach places and the quality of rehabilitation accordingly, as well as positively affects the morphological and functional results of the operation.

middle ear microsurgery in children, endoscopic surgical procedures, middle ear, cholesteatoma, tympanoplasty

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«Bulletin of problems biology and medicine» Issue 2 Part 2 (165), 2022 year, 184-191 pages, index UDK 616.284-002-006-089.8-072.1-053.2

10.29254/2077-4214-2022-2-2-165-184-191