The feasibility of TEES in pediatric patients
In recent years, an increasing number of studies have proven the
benefits of TEES in managing middle ear diseases [10-20]. For the
management of cholesteatoma, better visualization of the residual
cholesteatoma in the hidden space can be provided by an endoscope [1,
5, 6, 10-20]. Such an endoscope can also provide a high-resolution
image in order to clearly identify the tympanic segment of the facial
nerve. The facial recess can be easily explored using an endoscope with
an angle-view without curetting or drilling the surrounding structure
around the facial nerve [4, 9]. Furthermore, with the transcanal
endoscope-assisted middle ear surgery, most of the healthy structures
and mastoid air cells, as well as the mucosal gas exchange and mastoid
buffer, can be preserved, which are crucial for restoring middle ear
function and reducing post-surgical morbidity [1, 2, 6, 20]. Muaaz
et al. have also suggested that the time needed for endoscopic ear
surgery is shorter than that required for traditional microscopic ear
surgery. Using the endoscopic transcanal approach facilitates faster
access to the pathologic lesion directly through the ear canal without
drilling the mastoid cavity, which may thus significantly reduce the
surgical time [4].
Most of the previous studies were conducted in adult patients, while few
were conducted in pediatric patients. Studies on the applicability of
TEES in pediatric patients are lacking, and thus the efficacy and
feasibility of TEES in children remains controversial. The external
auditory canal (EAC) in children is shorter and narrower than that of
adults, and whether this may limit the application of TEES in pediatric
patients with middle ear disease is still under investigation. In a
study by Sun et al. on the anatomical applicability of TEES in children,
the authors provided anatomical evidence and suggested that TEES can be
a safe and effective alternative in the treatment of middle ear disease
in children with appropriate endoscopes and instruments [21]. Some
authors have already reported the successful clinical application of
endoscopes in middle ear surgery in children [22-24].
Our study showed that the pediatric patients can have as good surgical
outcomes (including the rates of surgical success, postoperative
complications, and postoperative hearing gain) as adult patients,
regardless of the surgical procedure. The surgical time required for
TEES management of cholesteatoma was similar in both the pediatric and
the adult patients. Although the surgical time of tympanoplasty was
longer in children, it still fell within an acceptable range.