A Study of Paediatric Squamosal Ear Disease and Early Post Operative Outcomes in a Paediatric E.N.T Unit of a Teritiary Teaching Hospital in South India

Rashmi Tanya Boaz, (2020) A Study of Paediatric Squamosal Ear Disease and Early Post Operative Outcomes in a Paediatric E.N.T Unit of a Teritiary Teaching Hospital in South India. Masters thesis, Christian Medical College, Vellore.


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BACKGROUND: Paediatric squamosal ear disease is a cause of significant morbidity in early childhood. Most of the current information on paediatric cholesteatoma is based on western statistics. There is a dearth of baseline characteristics of paediatric squamosal ear disease in developing countries like India. AIM OF THE STUDY: To study characteristics of paediatric squamosal ear disease and early post-operative outcomes. METHODS: Children who presented to the out-patient clinic with squamosal ear disease and underwent surgery between July 2017 and December 2018 were recruited. A detailed questionnaire was used to document demographic data, assess disease characteristics and assess the presence and severity of hearing loss. Degree of hearing loss was determined by the Pure Tone Audiogram test both pre-operatively and post-operatively. On review, at the early follow up visit within 3-6 months, a routine ENT examination was performed, and data updated with repeat audiogram. RESULTS: Ninety-two children were recruited for this study with an average age of ten. Majority belonged to the lower socio-economic classes and had risk factors like overcrowding, allergy history etc. Only 29.3% of our subjects were domicile in the same state of Tamil Nadu and nearby Andhra Pradesh with the rest from far northern regions. Commonest complaint was ear discharge and pars tensa disease was more prevalent. None of our patients presented with complications. On imaging, more than 70% of patients had disease in the epitympanum, the mesotympanum including sinus tympani, antrum, mastoid air cells with the most commonly involved site on scan being the epitympanum (81.9%) Intra-operatively 76% of the patients (72 of the 92) had disease in the epitympanum. The most common ossicle affected was the Incus (80.4%) Majority of the surgeries performed were canal wall up procedures (82.6). The most common ossicular reconstruction was type 3b in CWU surgeries while it was Type 3c in CWD. All the patients with moderate hearing loss had an abnormal incus. More than half of the children had improvement in the air- bone gap irrespective of the type of surgery. The group that benefited from the most change, were those with pre-operative moderate hearing loss. All 92 cases were reviewed at one week post-operatively. Three cases had minimal gaping of the post-aural wound, which was treated conservatively. Seventy-eight (84.8%) of the patients were followed up at 3-6 months. Of these, 12.7% of those who underwent CWU procedures and 6.7 % of those who underwent CWD, had a suspicion of recurrence. CONCLUSION: In our study of 92 cases hearing outcomes were found most beneficial in those children who had a pre-existing moderate hearing loss. There was a significant correlation between incus status and hearing. Our patients had no early complication except for three cases of wound dehiscence. On follow up suspicion of recurrent disease was found in 12.7% of those who under CWU surgery and in6.7% of those with CWD surgery. Follow up is a cause for concern with most of our patients travelling long distances but we had a follow up of 84.8%.

Item Type: Thesis (Masters)
Additional Information: 221714355
Uncontrolled Keywords: Cholesteatoma, Paediatric, Squamosal ear disease.
Subjects: MEDICAL > Otolaryngology
Depositing User: Subramani R
Date Deposited: 15 Feb 2021 05:26
Last Modified: 15 Feb 2021 05:26
URI: http://repository-tnmgrmu.ac.in/id/eprint/14236

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