Acquired cholesteatoma in children : clinical features and surgical results

Abstract EN

Acquired cholesteatoma in children is an aggressive disease due to its rapid growth and high recurrence rate.

Objective: To assess clinical features of cholesteatoma in children and evaluate our experience in the surgical management of this disease.

Methods: Fourty children aged 5–16 years operated on for acquired middle ear cholesteatoma (2002–2011), were included in our study.

Surgery was bilateral for 3 patients, which makes a total number of 43 operated ears.

Functional and anatomical results were evaluated after a minimum follow-up of 3 years.

Results: Mean age at the first operation was 11.7 years.

Canal wall-up tympanoplasty (CWUT) was performed as first-line procedure in 74% of cases.

Canal wall-down tympanoplasty (CWDT) was performed in 26% of cases when cholesteatoma was hardly controllable with a CWUT.

Cartilage graft was used in all cases for eardrum reinforcement.

After a mean interval of 12.2 months, second look procedure aimed to verify a residual cholesteatoma in 8 cases and perform an ossiculoplasty in one case.

Total cholesteatoma recurrence rate was 18% with CWUT and 9% with CWDT (p= 0.4).

Predictive factors for recurrence were: children < 10 years (p= 0.02) and ossicular chain resorption (p= 0.04).

Post-operative ABG 6 25 dB was seen in 53% of CWUT against 18% of CWDT (p= 0.04).

Conclusion: CWUT is the optimal management technique offering better hearing results, however, prevention of recurrences are considered to be better with CWDT.