经耳道全耳内镜技术在儿童中、内耳手术中的应用.

Objective A retrospective analysis of pediatric cases of total endoscopic ear surgery (EES) through the auditory canal was made to explore the indications, preoperative evaluation, and key points of intraoperative application of EES in children’s middle and inner ear surgery. Our purpose was to promote the application of the visualized and minimally invasive technology in children’s middle and inner ear surgery. Methods A retrospective analysis of the patients with EES from Beijing Children’s Hospital from January 2016 to January 2021 was made. The patients’ age, disease name, preoperative temporal bone CT findings, hearing, intraoperative findings, and postoperative follow-up were included. The key points of preoperative evaluation and the clinic paths were summarized. Results A total of 123 cases (123 ears) of EES were collected, including 70 cases (70 ears) of tympanoplasty, 30 cases (30 ears) of middle ear cholesteatoma resection, and 23 cases (23 ears) of cerebrospinal fluid otorrhea repair. The minimum age was 1 year and 1 month, and the maximum age was 17 years. The median age for tympanoplasty was 8 years and 5 months. The median age for middle ear cholesteatoma resection with ossicular chain reconstruction was 4 years and 3 months, and the median age for cerebrospinal fluid (CSF) otorrhea repair was 4 years and 2 months. The transverse diameter of the external ear canal (EAC) in children undergoing tympanoplasty was 5.0~7.15 mm, and the longitudinal diameter was 4.5~6.5 mm. The transverse diameter of the EAC in children undergoing middle ear cholesteatoma resection was 4.6~6.0 mm, and the longitudinal diameter was 4.5~6.5 mm. The transverse diameter of the EAC in patients with CSF otorrhea was 4.5~6.0mm, and the longitudinal diameter was 4.5~6.5 mm. Children with middle ear cholesteatoma had lesions limited to the middle tympanic cavity. Five cases had lesions limited to the upper tympanic cavity. Ten cases of lesions located in both the middle and upper tympanic cavities. Ten cases involved the superior recess of the eustachian tube and/or the tympanic sinus. Six children with tympanic sinus cholesteatma underwent intraoperative combined use of 0 ° and 70 ° endoscopes. The fistula of CSF otorrhea repair surgery was located at and around the vestibular window. After removing the stapes, varying degrees of bone defects could be seen on the base plate.Tympanoplasty classification: 66 cases of type Ⅰ, 1 case of type Ⅱ, and 3 cases of type Ⅲ. The postoperative hearing result of patients undergoing middle ear cholesteatoma resection or tympanoplasty was better than before(P＜0.001). Two (2/66) children with type Ⅰ tympanoplasty had small perforations of the tympanic membrane six months after surgery, and the remaining patients had good healings of the tympanic membranes. There had been no recurrent cases of cholesteatoma. Two cases of CSF otorrhea underwent secondary endoscopic closure due to the recurrence of otorrhea after surgery, and no recurrence happened again. Conclusions EES in children could be suitable for middle and inner ear surgery and might achieve good prognosis. Preoperative evaluation of ear canal width, lesion range, and leak location was the guarantee for a successful EES [ABSTRACT FROM AUTHOR]