Chronic suppurative inflammation of the middle ear in children

INTRODUCTION Chronic suppurative inflammation of the middle ear (HGO) in children represents one of the most frequent infections in childhood, even in children from developed industrial countries. We can distinguish two types of chronic suppurative inflammation: first - HGO without cholesteatoma and second HGO with cholesteatoma. OBJECTIVE The objective of the paper was to point out the characteristics of chronic suppurative inflammation of the middle ear in children and possible methods of treatment. METHOD From 2000 to 2005, our retrospective study involved 92 children, aged 2 to 16 years, treated for chronic suppurative inflammation of the middle ear and subsequent otogenic complications. The diagnosis was established based on clinical symptoms, otoscopic and otomicroscopic findings. Treatment included the removal of the pathological process, reconstruction of the hearing chain and prevention recurrence. RESULTS We performed 111 surgical interventions. Children were divided into two groups: in the first group, we performed 56 surgical interventions in 48 children diagnosed with chronic suppurative otitis without cholesteatoma, and in the second group we performed 55 surgical interventions in 44 children who were diagnosed with chronic otitis with cholesteatoma. In the first group we performed mastoidectomy in 17 (32.5%) children, mastoidectomy and posterior aticotomy in 5 (9.5%), miringoplasty in 22 (35.8%), timpanoplasty type II in 5 (9.5%), timpanoplasty type III in 3 (5.6%) and timpanomastoidectomy in 4 (7.1%) children. In the second group, consisting of children diagnosed with cholesteatoma of the middle ear, we performed 47 first act surgeries, using closed technique in 17, and open in 30 cases. We performed timpanoplasty type III in 17 (30.9%) and timpanomastoidectomy in 17 (30.9%), and timpanoplasty type II in 9 (16.4%), timpanoplasty type IV in 10 (18.2%) and mastoidectomy in 2 (3.6%) children. In the group treated by closed surgical technique recurrence occurred in 5 (29.4%), and in those treated by open technique in 3 (10.3%). Two children had bilateral cholesteatoma. CONCLUSION Further research should be directed toward the identification of different types of factors and pathogenesis of HGO. Treatment of this decease is still considered controversial. Hinolon drops could represent a promising option in the treatment of HGO. The main objective in the treatment of cholesteatoma should be the improvement of the open technique to prevent retraction pockets, decrease of the rate of residual or atelectatic process and the improvement of hearing results.