Is pediatric cholesteatoma more aggressive in children than in adults? A comparative study using the EAONO/JOS classification.

INTRODUCTION: chronic otitis media with cholesteatoma (COMC) is a serious condition that may cause severe complications. According to the literature, in pediatric patients this entity can have a more aggressive behavior, leading to higher rates of morbidity. Consensus regarding the definition of aggressive and extensive cholesteatoma was lacking until recently. European Academy of Otology and Neurotology/Japan Otologic Society (EAONO/JOS) proposed a classification and staging system which was highly accepted by a group of otology experts. OBJECTIVE: to compare cholesteatoma characteristics between pediatric and adult patients using the EAONO/JOS stating system. MATERIAL AND METHODS: a retrospective analysis of the patients who underwent surgery for cholesteatoma treatment in a tertiary hospital was performed using EAONO/JOS classification. Congenital cholesteatoma, revision surgery, and follow-up losses were excluded. The patients were further divided into two cohorts: a pediatric group (<16 years old) and an adult group (>16 years old). The results were compared between them. RESULTS: 134 patients fulfilled the inclusion criteria, 27 were pediatric, and 107 adult patients. We found a significant difference in supratubal recess, with higher rates of extension to this location in the pediatric group. Also in the pediatric cohort, COMC was accompanied by malleus erosion in a higher frequency, with a significant difference from adults; it also presented in higher stages of the disease according to EAONO/JOS classification. We found no differences in hearing gain post-operatively. Moreover, we found that age younger than 16 years was an independent risk factor for relapse with time. DISCUSSION AND CONCLUSIONS: according to our data, cholesteatoma in pediatric age has a more aggressive and extensive nature than in adults, and age younger than 16-years-old is an independent risk factor for relapse.

Infectious complications in head and neck surgery: Porto Oncology Centre retrospective analysis / Complicaciones infecciosas en cirugía de cabeza y cuello: análisis retrospectivo del Instituto de Oncología de Porto

Objective: To analyze the impact of infectious complications and microbiology in the postoperative period after major oncologic neck surgeries. Methods: A retrospective study conducted in an oncology center, including all the consecutive patients who developed infectious complications after major neck cancer surgery, from October 2012 to May 2016 (44 months). Among other data, we collected TNM stage, ASA score, body mass index, comorbidities and habits, pre and postoperative hemoglobin levels, albumin serum levels, pre-surgical treatments, length of inpatient stay, isolated microbiological agents and the recorded complications and mortality rate. Results: In the studied period, 761 major neck surgeries were performed. Of these, 96 patients had complications (12.6%). Pharyngocutaneous fistula (PCF) was the most frequent complication (56%) and nosocomial pneumonia was the most common systemic complication (23%). Pseudomonas aeruginosa was the principal microorganism of the 26 species isolated (15%). 12 deaths were registered. Using multiple linear regression we concluded that flap/cutaneous necrosis and PCF were complications with statistical significance that prolonged inpatient stay. The same complications had significant relative risk for more than 30 days of hospitalization. Conclusion: The postoperative period is critical for the successful treatment of head and neck oncology patients. PCF and flap/cutaneous necrosis were the principal complications which worsened the outcomes during this critical period. The early recognition and treatment of these complications is crucial

Objetivo: Analizar el impacto de las complicaciones infecciosas en el período posoperatorio de las cirugías oncológicas mayores de cabeza y cuello, y estudio de los agentes microbianos implicados. Métodos: Estudio retrospectivo realizado en un instituto oncológico, en pacientes que desarrollaron complicaciones infecciosas después de la cirugía oncológica mayor de cuello, entre octubre de 2012 y mayo de 2016 (44 meses). Entre otros se recogieron el estadio TNM, la puntuación ASA, el índice de masa corporal, las comorbilidades, los hábitos tóxicos, los niveles de hemoglobina pre y postoperatoria, los niveles séricos de albúmina, los tratamientos previos a la cirugía, la duración de la hospitalización y los microorganismos aislados, así como las complicaciones sufridas y la tasa de mortalidad. Resultados: En este período se realizaron 761 cirugías cervicales mayores. De estas, 96 pacientes presentaron complicaciones (12,6%). Las que con mayor frecuencia se registraron fueron la fístula faringocutánea (FFC) (56%) y la neumonía nosocomial (23%). Fueron aislados 26 tipos de microorganismos, siendo la Pseudomonas aeruginosa la más frecuente (15%). Se registraron 12 fallecimientos. Tras el estudio estadístico con regresión lineal múltiple, se detecta que la necrosis cutánea o del colgajo y la FFC fueron las complicaciones con un mayor impacto estadístico en la estancia hospitalaria. Asimismo, fueron los factores que más influyeron en las hospitalizaciones de 30 días o más. Conclusión: Una buena evolución durante el período postoperatorio es fundamental para obtener éxito en el tratamiento de los pacientes oncológicos de cabeza y cuello. La FFC y la necrosis de colgajo o cutánea constituyeron las principales complicaciones con un mayor impacto en los resultados obtenidos. La detección precoz de estas complicaciones, así como su tratamiento, son cruciales

Infectious complications in head and neck surgery: Porto Oncology Centre retrospective analysis.

OBJECTIVE: To analyze the impact of infectious complications and microbiology in the postoperative period after major oncologic neck surgeries. METHODS: A retrospective study conducted in an oncology center, including all the consecutive patients who developed infectious complications after major neck cancer surgery, from October 2012 to May 2016 (44 months). Among other data, we collected TNM stage, ASA score, body mass index, comorbidities and habits, pre and postoperative hemoglobin levels, albumin serum levels, pre-surgical treatments, length of inpatient stay, isolated microbiological agents and the recorded complications and mortality rate. RESULTS: In the studied period, 761 major neck surgeries were performed. Of these, 96 patients had complications (12.6%). Pharyngocutaneous fistula (PCF) was the most frequent complication (56%) and nosocomial pneumonia was the most common systemic complication (23%). Pseudomonas aeruginosa was the principal microorganism of the 26 species isolated (15%). 12 deaths were registered. Using multiple linear regression we concluded that flap/cutaneous necrosis and PCF were complications with statistical significance that prolonged inpatient stay. The same complications had significant relative risk for more than 30 days of hospitalization. CONCLUSION: The postoperative period is critical for the successful treatment of head and neck oncology patients. PCF and flap/cutaneous necrosis were the principal complications which worsened the outcomes during this critical period. The early recognition and treatment of these complications is crucial.