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.