title: Transcanal endoscopic ear surgery for pediatric population with a narrow external auditory canal.
abstract: OBJECTIVE
  To retrospectively determine the size of the external auditory canal (EAC) in a pediatric population and to describe our experience with transcanal endoscopic ear surgery (TEES) in this pediatric population which had been successfully treated for middle ear disease using TEES.
  
  
  METHODS
  We analyzed 31 patients ranging in age from 2 to 13 years old (median: 7.6 years) with middle ear disease who underwent TEES between November 2011 and August 2014. Sixteen of these patients had surgery for cholesteatomas; 11 for chronic otitis media; and 4 for malformation of the middle ear. A preoperative CT scan was performed to evaluate the middle ear disease. Transcanal endoscopic tympanoplasty was performed using a rigid endoscope with a 2.7mm outer diameter. Transcanal endoscopic atticoantrotomy was also performed, as necessary, on some patients to access pathologies in the antrum. The values of anterior-posterior diameters and superior-inferior diameters of the bony parts of EAC were measured retrospectively based on the preoperative CT scan data.
  
  
  RESULTS
  TEES was successfully performed in all 31 pediatric patients without resorting to a retroauricular incision. Twenty-seven patients were evaluated for postoperative hearing levels which were found to fall within an acceptable range and for postoperative air-bone gap (ABG) by pure tone audiometry with a resulting mean of 8.6dB. The smallest anterior-posterior diameters of the external ear canal ranged from 3.2 to 7.1mm (5.0±1.0mm) and the smallest superior-inferior diameters ranged from 3.4 to 10.3mm (5.9±1.3mm).
  
  
  CONCLUSIONS
  TEES can be used to safely and effectively treat middle ear disease even in the pediatric population in its narrow EAC.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata-shi, Yamagata 990-9585, Japan. Electronic address: tuito@med.id.yamagata-u.ac.jp.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata-shi, Yamagata 990-9585, Japan.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Kubota
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata-shi, Yamagata 990-9585, Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata-shi, Yamagata 990-9585, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Futai
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata-shi, Yamagata 990-9585, Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Furukawa
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata-shi, Yamagata 990-9585, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Kakehata
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D004424:Ear Canal / Q000033:anatomy & histology*; D004432:Ear, Middle / Q000002:abnormalities / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D010033:Otitis Media / Q000601:surgery*; D012189:Retrospective Studies
keywords: Children; Cholesteatoma; Chronic otitis media; Hearing results; Transcanal endoscopic ear surgery; Tympanoplasty