Objectives: To compare the endoscopic approach to manage attic cholesteatoma with conventional microscopic technique. Design: Randomized controlled trial. Participants: A total of 190 patients (192 ears) diagnosed with attic cholesteatoma extending to the antrum area (stages Ib and II) were randomly assigned into two groups: one undergoing endoscopic approach and the other undergoing the microscopic technique. Main outcome measures: The two groups were compared in terms of preoperative and intraoperative findings, access to hidden areas expressed in terms of the Middle Ear Structural Visibility Index (MESVI), mean operative time, and postoperative findings. Results: No difference in the parameters of the preoperative and intraoperative findings analyzed (patient age, computed tomography findings, disease stage, and intraoperative cholesteatoma characteristics) was observed between the endoscopic and microscopic groups. The median MESVI for the endoscopic group was better than that for the microscopic group (P<0.05). The mean operating time using the endoscopic approach was less than that using the microscopic approach (P<0.05). The median postoperative pain score in the endoscopic group was lower than that in the microscopic group (P<0.05). No significant difference was found between the two groups in terms of taste sensation, air-bone gap closure at the end of 4 weeks, and vertigo experienced at the end of the first week. When long-term surgical outcomes were assessed 1 year postoperatively, five patients in the microscopic group had recurrence, four had cartilage displacement, three had perforation, and five had retraction pocket formation. In the endoscopic group, four patients had disease recurrence, three had cartilage displacement, two had perforation, and four had retraction pocket formation. Conclusion: Endoscopic management of limited attic cholesteatoma showed definite advantages over the conventional microscopic approach, such as providing better visualization, requiring less postoperative time, subjecting the patients to less pain, and decreasing the incidence of complications.

Abstract: Purpose: We aimed to evaluate whether early TRAP exposure is associated with the development of AR during preschool years, stratified by sex, parental allergy, or stressful family events. Methods: A nested case-control study including 398 was conducted in Shenyang. TRAP exposure in early childhood was estimated by nitrogen oxides (NOx) air dispersion modeling. We used multinomial logistic regression models to assess the association between early TRAP exposure and preschool children AR, stratified by potential confounders including sex, parental allergy, or stressful family events. Results: Life-time prevalence of AR in children aged 4 years (6.4%) was associated with TRAP exposure during early children, with an increased odds ratio (OR) [adjusted OR=2.18; 95% confidence interval (CI),1.35 to 3.52] for an interquartile range (38 μg/m3) increase in NOx levels. A relative risk for AR of of 1.88 (95% CI, 1.26 to 2.81) with boys, of 1.91 (95% CI, 1.28 to 2.85) among with eczema during the first year, of 2.94 (95% CI, 1.77 to 4.87) with parents allergy, of 4.14 (95% CI, 2.65 to 6.49) with stressful family events, was also observed. TRAP exposure was significantly associated with AR in preschool children who are boys (adjusted OR=2.13; 95% CI, 1.31 to 3.45), with parental having allergy (adjusted OR=2.06, 95% CI, 1.27 to 3.36), and a history of stressful family events (adjusted OR=1.94, 95% CI, 1.18 to 3.20). Conclusions: Early childhood TRAP exposure, boys, parental allergy, stressful family events may contribute to AR in children at 4 years of age.

Purpose: We aimed to evaluate whether early TRAP exposure is associated with the development of AR during preschool years, stratified by sex, parental allergy, or stressful family events. Methods: A nested case-control study including 398 was conducted in Shenyang. TRAP exposure in early childhood was estimated by nitrogen oxides (NOx) air dispersion modeling. We used multinomial logistic regression models to assess the association between early TRAP exposure and preschool children AR, stratified by potential confounders including sex, parental allergy, or stressful family events. Results: Life-time prevalence of AR in children aged 4 years (6.4%) was associated with TRAP exposure during early children, with an increased odds ratio (OR) [adjusted OR=2.18; 95% confidence interval (CI),1.35 to 3.52] for an interquartile range (38 μg/m3) increase in NOx levels. A relative risk for AR of of 1.88 (95% CI, 1.26 to 2.81) with boys, of 1.91 (95% CI, 1.28 to 2.85) among with eczema during the first year, of 2.94 (95% CI, 1.77 to 4.87) with parents allergy, of 4.14 (95% CI, 2.65 to 6.49) with stressful family events, was also observed. TRAP exposure was significantly associated with AR in preschool children who are boys (adjusted OR=2.13; 95% CI, 1.31 to 3.45), with parental having allergy (adjusted OR=2.06, 95% CI, 1.27 to 3.36), and a history of stressful family events (adjusted OR=1.94, 95% CI, 1.18 to 3.20). Conclusions: Early childhood TRAP exposure, boys, parental allergy, stressful family events may contribute to AR in children at 4 years of age.