Pediatric myringoplasty: Postaural versus transmeatal approach

Objectives

Where various surgical options exist for solving the same problem, and the results are similar, Occam's razor may be a suitable way of deciding which technique to use.The postaural [retroauricular] approach in myringoplasty is favoured generally, for its reported better overview of the middle ear. However, due to increasing interests in both patients’ comfort and a more efficient use of operating time, transmeatal approach is a good alternative. The aim of this study is to investigate the difference in success rates between these two approaches and the factors that contribute to success.

Methods

Retrospective case note study. Cases that achieve tympanic membrane (TM) closure, within 1-year post-operative are considered to be successful.

Patients

A group of 218 ears in 180 patients (median age 10.0, range from 5 to 18 years) who had undergone either postaural or transmeatal myringoplasty with or without ossicular reconstruction. Age, gender, site and size of the perforation, underlying cause of the perforation and status of contralateral ear were recorded. The patients were followed at 6 days, 7 weeks and then every 6 months to determine the incidence of TM closure. Audiograms were taken preoperatively, at 7 weeks and between 7 and 15 months post-operative.

Results

The overall success rate was 78.9%. The difference in the success rates of the two approaches, 79.8% of postaural myringoplasty against 78.4% of transmeatal myringoplasty, is not significant (p = 0.81). Post-operative air bone gap (ABG) is significantly improved when compared to that of preoperative (p ≤ 0.01). Younger age (5-6 years old) is associated with a lower success rate. Though their hearing is significantly improved, the difference is clinically irrelevant.

Conclusion

Postaural and transmeatal approaches in myringoplasty have comparable closure rate. Occam's razor would in this situation indicate the use of the simplest/fastest technique with the lowest morbidity; in this situation the transmeatal approach. Since younger age is associated with lower success rate, it is recommended to postpone surgery until the age of 7 is reached.     

Postaural inflammatory pseudotumor: an extremely unusual complication of trauma in a child

We report the case of a 12-year-old boy who presented with a rapidly enlarging, painless mass behind the ear following trauma to the area. The mass was excised, and histopathologic and immunohistochemical evaluations revealed it to be an inflammatory pseudotumor. At 1 year postoperatively, the child exhibited no evidence of recurrence.     

鼻部大汗腺腺瘤一例

患者男,64岁,发现鼻尖右侧肿物7年.查体:鼻尖右侧近肤色光滑类圆形肿物,质中,直径约1.5～2.0 cm,无触痛,无渗出.患者7年前发现鼻尖右侧肿物,绿豆大小,无疼痛及渗液,当地医院给予手术治疗,术后病理为"皮脂腺瘤".半年后在同一部位又长出类似肿物,且逐渐增大,无疼痛及发痒,无破溃及渗出.2008年1月在我院用高功率CO:     

Tubular apocrine adenoma with syringocystadenoma papilliferum arising from the external auditory canal

Tubular apocrine adenoma (TAA) is a very rare sweat gland tumour. Comprehensive review of the literature reveals that TAA in the external auditory canal (EAC) has not yet been reported. We report a case of TAA in the EAC, together with characteristic histopathological findings.     

Collision tumor of apocrine carcinoma and squamous carcinoma occurring in the ear

An unusual case of a cutaneous collision tumor comprised of a squamous cell carcinoma and an apocrine carcinoma occurring in the auricle of an 82-year-old man is presented. Microscopic study confirmed 2 distinct tumors: a squamous cell carcinoma arising in the epidermis and an adjacent apocrine carcinoma. We discuss the diagnostic criteria and review pertinent recent literature. To our knowledge, this is the first English language report of such a collision tumor.