Background and aims Cholesteatoma remains a relatively common cause of permanent conduct deafness, moderate at children and adults. Cholesteatoma incidence is not known, but remains a common indication for otological surgery, with a peak incidence in the second decade of life.
Highlighting a less common clinical manifestation in a teenager – cholesteatoma – benign tumour with the capacity of destroying the surrounding bone, occurs due to proliferation of the epidermis within the middle ear.
Methods Tracking the clinical course of a 15 year-old patient, who arrived at emergency paediatric service with pain in the left ear, swelling of the retoauriculare and left pretragiene region, affirmative debut of 48 hours. The adolescenct is urgently hospitalised in otorhinolaryngology department.
Anamnesis - Patient in recent history, with the birth of a female child living 9 months ago, at the time of consultation with evolving eight-week pregnancy; so with recurrent painless otorrhea
Left otoscopy – the external ear canal with abundant purulent secretions; after posterolateral upper wall suction, ear canal is down – patogneumonic sign of mastoiditis, throbbing otorrhea
Functional examination – audiometry was performed before surgery and indicated a pure hearing loss transmission, with the raising of the acoustic threshold to the ear sick. Negative Rinne at the affected ear, prolonged Schwabach and extended Weber.
Paraclinical examination - the serodiagnosis investigations etiologically targeted to detect the presence of Proteus mirabilis with sensitivity to cephalosporins, III and IV generation, and generation II quinolones
Correct diagnosis is placed intraoperatively – antromastoidectomie
Histology cholesteatoma squamous epithelium typically removed surgically highlights.
Results Based on history, clinical and laboratory examinations, the following diagnosis was established: Chronic acutizat effusion otomastoiditis, protrudes retroauricular and temporo-zygomatic; Secondary cholesteatoma acquired. Eight-weeks pregnancy in evolution. Iron deficiency anaemia – moderate form.
It was considered secondary cholesteatoma acquired a lesion type drills, as a result of acute otitis media neglected. Since cholesteatoma is not vascularized, when the infection is difficult to treat because systemic antibiotics can not penetrate only superficially which explains the recurrence and resistance to them and the local evolution.
Medical therapy is not a viable treatment for cholesteatoma, surgical technique and decision-channel open or closed depends on various factors.
Contraindication to surgical therapy are just of medical nature. Here, a choice between recommending a therapeutic abortion and interfering urgently with both medical and surgical treatment, was presented to the patient‘s legal representative – the mother, who agreed with the specialised treatment.
It is important to mention that, in this situation, superior imaging – CT scan was not conducted, considering also the possibility of the decision not to perform therapeutic abortion, taking into account the cooperation and the more difficult post discharge tracking. However, because imagery technique is preferred, showing the extension balance of the lesion, this remains to be performed in the post discharge dynamic.
Short term postoperative evolution was favourable; the patient was released after two-weeks hospitalisation, having as complication just the keeping of a light transmission deafness.
ConclutionS The correct antibiotics according to the time and the sensitive microbial criteria, associated with surgical drainage specific to each clinical case, remain the two steps of otomastoiditis and cholesteatoma’s treatment, which are completed also by a right addressability to specialised medical services, because suppurative disease of the middle ear are directly correlated, as frequency and severity, to the social condition and medical assistance of the population.
If not detected and treated on time, cholesteatoma, because of the potential to erode and destroy important structures of temporal bone, can lead to powerful complications of the central nervous system, such as meningitis, brain abscess, sigmoid sinus thrombosis, potentially unfavourable and even death.