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  • Title: [Clinical characteristics in children with cleft palate associated with middle ear cholesteatoma].
    Author: Yang Y, Chen M, Hao JS, Liu W, Zhang J.
    Journal: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi; 2017 May 07; 52(5):377-380. PubMed ID: 28558458.
    Abstract:
    Objective: To summarize the characteristics of children diagnosed as cleft palate associated with middle ear cholesteatoma. Methods: There were five middle ear cholesteatoma cases who had previously received cleft palate repairment surgery. All of the patients were followed up for 17 to 47 months. Median follow-up time was 31 months. Results: There were three males and two females with three to eleven years old , and the average of age was seven years and ten months. The time of cleft palate repairment surgery was from six months to four years, and the average age was one year and nine months. No history of grommet insertion. Three cases were unilateral choleateatoma (right ear in two cases and left ear in one case, of which two cases of contralateral ear with secretory otitis media) and two cases were bilateral choleateatoma. Five cases(seven ears) received surgeries. Radical mastoidectomy + canal wall down tympanoplasty were performed in three ears, in which we found stapes disappeared. Radical mastoidectomy + canal wall up tympanoplasty were performed in four ears, in which we found intact foot plate, with recurrence occurred in one case nine months after the first surgery. No recurrence occurred after the second canal wall down tympanoplasty. The postoperative average hearing thresholds of air conduction were improved in different degrees. Conclusions: There may be a relationship between cleft palate associated with middle ear cholesteatoma and no grommet insertion history. The incidence of bilateral cases is relatively high, and otitis media with effusion may occur because of poor Eustachian tube function in the unilateral cases. Choice of surgical methods should be decided basing on combination of decreasing the recrudescence and improving the hearing. 目的： 总结并分析儿童期腭裂合并中耳胆脂瘤患儿的临床表现及手术效果。 方法： 2009年2月至2015年5月间北京儿童医院共收治5例既往曾行腭裂修补术的中耳胆脂瘤患儿，分析其临床表现、手术方式及疗效情况。 结果： 5例患儿中男3例、女2例，年龄3～11岁、平均7岁10个月；接受腭裂修补术时年龄为6个月至4岁，平均1岁9个月。单耳发病3例，其中2例对侧耳合并有分泌性中耳炎，双耳发病2例，均无鼓膜置管史。5例(7耳)患儿均接受手术治疗，3耳术中发现镫骨烂失，行乳突根治术＋开放式鼓室成形术；4耳术中发现镫骨上结构部分受损，但镫骨底板完整，行乳突根治术＋完璧式鼓室成形术，其中1耳术后9个月复发，二次开放手术后未再复发。术后随访17～47个月，无复发，气导平均听阈较术前均有不同程度改善。 结论： 儿童期腭裂合并中耳胆脂瘤患儿的发病可能与既往无鼓膜置管史有关，双侧发病比例相对较高，单侧发病者对侧耳也可因咽鼓管功能不良合并出现分泌性中耳炎。手术术式的选择需根据个体情况，既要考虑降低复发几率也要兼顾听力的改善。.
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