Le cholestéatome acquis de l’enfant : facteurs prédictifs de récurrence une étude rétrospective sur 11 ans

Abstract FRE

AIM OF THE STUDY : To define the predictive factors of recurrence of the pediatric acquired cholesteatoma in order to improve the long-term results, to restore a good hearing function and to prevent the complications.

PATIENTS AND METHODS : A retrospective study concerning all cases of pediatric acquired cholesteatoma, treated during the period 1997-2008 in our center, and followed up for at least one year.

A description of the parameters concerning the patients, disease and treatment as well as a univariate analysis were undertaken in order to determine the recurrence predictors.

The recurrence-free survival was calculated using the Kaplan-Meier method.

RESULTS : 26 ears were studied and followed over a mean period of 62 months after the first intervention.

The mean age was 12 years (11.7 years) with a 2.7 sexratio.

The main clinical presentations were otorrhea (65 %) and hypoacusia in 42 % of cases.

Fifteen cases (57.7 %) presented an extension to the mastoid, 50 % of the ears had an ossicular erosion and 11 cholesteatomas revealed a local or regional invasion.

Almost 3 / 4 (73 %) of the cholesteatomas were treated using a canal wall up surgery.

The cumulative rate of recurrence was 53.8 % and the rate of recurrencefree survival was 84 %, 56 %, and 44.7 % at 12, 24 and 36 months respectively.

Only the extension of the cholesteatoma to the mastoid, and the local and regional invasion (sinus tympani, lateral semi-circular canal, facial nerve recess, etc.) of the cholesteatoma at diagnosis, showed a significant higher risk of recurrence (p < 0.05).

CONCLUSION : In our study, the extent of the disease at diagnosis is considered as the major predictive factor of recurrence in pediatric acquired cholesteatoma population raising the problem of delayed diagnosis.