Surgical treatment of cholesteatoma in children

Abstract

Treating cholesteatoma in children is still controversial. This article reviews 93 cases of pediatric cholesteatoma operated on from 1983 to 1991 in the Gruppo Otologico, Placenza, Italy, and details the results in 83 children who underwent the intact canal wall technique. During second-stage surgery, residual cholesteatoma was detected in 38% of patients. Recurrent cholesteatoma was detected in 10% of patients treated with the intact canal wall technique. Residual cholesteatoma was seen in the middle ear cleft in 63%, in the epitympanum in 26%, and in the mastoid in 11% of cases. Social hearing level (< 25 dB) was achieved in 85% of cases with suprastructure, whereas only 53% of patients without suprastructure had these levels. In the treatment of cholesteatoma in children by use of the intact canal wall technique, a preplanned second-look operation is mandatory to eradicate the disease.

Retrograde mastoidectomy on demand with soft-wall reconstruction in pediatric cholesteatoma

“…In our study, socially acceptable hearing (30 dB HL or better) was achieved in 88% of the cases. Hearing results are reported to be satisfactory if patients have an intact stapes superstructure (type 3) and poor when they lack the stapes superstructure (type 4) (17,18). We found that 93.3% of the cases in which ossicular reconstruction was done in the presence of the stapes superstructure had acceptable social hearing levels as compared to only 80% of the cases where the stapes superstructure did not exist.…”

Pediatric cholesteatoma: A retrospective review

“…These statistics, however, may be misleading as some consider the planned secondlook procedure to be an essential part of the ICW technique. Therefore, it has been argued that the residual cholesteatoma is not a complication or failure of the initial procedure [3].…”

“…The disadvantage of the ICW procedure is that exposure to the epitympanum and sinus tympani may be limited and the technique is technically more difficult. As a result, residual and recurrence rates have typically been higher with ICW compared to CWD [2,3].…”

Algumas considerações sobre colesteatomas adquiridos pediátricos e adultos

“…Since the first report of mastoidectomy technique, in 1649, by Riolanus, up to today, the surgery has been through a gradual evolution, supported by field studies and technological development. However, surgical management of cholesteatomas in children is still the key controversy among otologists [93][94][95] . To define the best therapeutic strategy, especially in this special group of patients, it is necessary to consider many factors such as total eradication of the disease and preservation of auditory function; for the final decision, all factors should be properly considered and analyzed.…”