Cholesteatoma in the pediatric population: Prognostic indicators for surgical decision making

Abstract

A review of surgical therapy for pediatric cholesteatoma at the Arkansas Children's Hospital was performed. Fifty-three children treated surgically for cholesteatoma were studied over a 10-year period. Primary acquired, or attic retraction cholesteatomas, were generally treated with a canal up tympanomastoidectomy; there were very few complications or secondary procedures in this group. Middle ear or secondary acquired cholesteatomas were initially treated by both canal up and canal down procedures; however, a large percentage of these patients eventually required an open cavity procedure. The presence of cholesteatoma in the sinus tympani strongly predicted failure to control disease with a canal up procedure (P < .05); conversely, the absence of matrix in the sinus tympani was predictive for success when a canal up procedure was used for attic cholesteatoma (P < .05). Finally, it was determined that follow-up was not adequate in our patient population. With this in mind, guidelines for the management of pediatric cholesteatoma will be presented.

Cholesteatoma surgery in children: 10-year retrospective review

“…10 Factors such as surgeon experience, high facial ridge, inadequate meatoplasty, ossicular chain involvement and cholesteatoma extent have been reported to correlate highly with disease recurrence. 8,[11][12][13][14] In our study, eight of 25 ears demonstrated spontaneous improvement in air conduction thresholds 12 to 18 months following primary surgery. On reexploration, all eight cases had recurrent disease.…”

Clinical Aspects and Surgical Outcomes of Congenital Cholesteatoma in 93 Children: Increasing Trends of Congenital Cholesteatoma from 1997 through 2012

“…Pediatric CC tends to be more aggressive and extensive than CC in adults, and it is associated with a higher rate of recurrence [1011]. According to the report of Potsic, et al [12] the recurrence rate after surgery was 13% among patients with stage I CC and 25% among those with stage II CC, while Stapleton, et al [13] reported that 5% of patients with stage I CC and 24% with stage II CC had recurrence.…”

Pediatric cholesteatoma: A retrospective review

“…Other reports [9,10,[19][20][21][22] indicate that operator experience, patient age, ossicular chain involvement, cholesteatoma size and location, and disease left behind at time of surgery correlate with recurrent disease. Most authors agree that recurrence is much more commonly seen when disease involves the round window, sinus tympani and ossicular chain in the posterior-superior quadrant.…”

“…We agree with this conclusion and found the majority of our recurrences for both types of approaches were in the posterior/superior quadrant (Chart 3). Stern and Fazekas-May [21] demonstrated that the presence of disease in the sinus tympani necessitates a CWD procedure in 86-92% of patients. However, others argue that sinus tympani disease can still be explored with an ICW via a retrofacial approach with the aid of an endoscope for examination of the deep recess [2].…”