Pediatric Cholesteatoma: An Individualized, Single‐Stage Approach

Abstract

We report our experience with a one-stage surgery for pediatric cholesteatoma in 216 ears. Our technique is based on three main principles: (1) the surgery is individualized; (2) the goal of surgery is to completely remove cholesteatoma and related disease in one operation; and (3) the reconstruction is performed to provide both good hearing and a dry, trouble-free ear. The incidence of recidivism was 10.2%, and the rate achieved was 13.3% at 5 years and 24% at 10 years. Canal wall down surgery was the predominant procedure used. The incidence of intraoperative neurosensory hearing loss, vertigo, and facial nerve injury was extremely low. The postoperative cavity problems encountered were minimal.

Pediatric cholesteatoma: A retrospective review

“…In this series, 79% of children with cholesteatoma were initially managed using an ICW approach, with only 4.5% (10/ 221) of these cases eventually requiring a CWD procedure. There was an overall recurrence rate of 16%, with an ICW rate of 17% and a CWD rate of 12%, which is consistent with the literature [2,[9][10][11][12][13][14] ( Table 2).…”

“…Regardless of technique, recurrence rates for adults and children are between 7 and 57% [2,[9][10][11][12][13][14]. However, Tos et al [15] reported results on 740 patients and found no differences in recurrence rates between the two approaches and fewer complications with ICW.…”

Mastoid Obliteration for Pediatric Suppurative Cholesteatoma: Long-Term Safety and Sustained Effectiveness after 30 Years' Experience with Cartilage Obliteration

“…Therefore, performing a second, third or even fourth look can be an unnecessary hardship for both the child and the family. This observation is supported by Parisier et al [1996], who proposed that cholesteatomas can be exenterated safely in one stage using either the CWU or CWD techniques. Additionally, due to the late recidivism of residual cholesteatomas (mean detection time 5 years, maximum 11.6 years), it may be better to wait for the disease to reappear instead of taking a second look at 6-18 months after surgery in all children.…”

Comparison of Echo-Planar Diffusion-Weighted Imaging and Delayed Postcontrast T1-Weighted MR Imaging for the Detection of Residual Cholesteatoma

“…However, these techniques are not routinely performed and canal wall-up (CWU) tympanoplasties for middle ear cholesteatoma usually require second-look surgery to rule out the presence of residual cholesteatoma, observed in 6%-57% of patients in large series. 4,5 Any reliable noninvasive method of detecting residual cholesteatomas could allow the avoidance of second-look surgery in patients with no hearing loss after the first surgery.…”