Factors affecting complications and comorbidities in children with cholesteatoma

Abstract

ObjectiveTo evaluate the effects of age, race, payer status, and socioeconomic status on complications and comorbidities in children with cholesteatoma. MethodsAn analysis of the Kids’ Inpatient Database was performed on cases of cholesteatoma between 2006 and 2016, along with associated complications or co-morbidities and surgical interventions. Results1552 cases of pediatric cholesteatoma represented 5.6 cases per 100,000 total discharges over the study period. The mean age was 9.9 (±5.4) years. Compared to children in the 4th age quartile, those in the 1st age quartile had decreased risk of conductive hearing loss (OR 0.64 [0.42–0.99]), venous thrombosis (OR 0.24 [0.06–0.88]), intracranial abscess (OR 0.35 [0.13–0.96]), and facial nerve palsy (0.44 [0.20–0.97]), but increased risk of chronic otitis media (OR 2.24 [1.23–4.10]). Compared to children identified as Other race, children identified as Black had increased risk of acute otitis media (OR 9.20 [1.35–62.78]). Both children identified as Black (OR 9.90 [1.48–66.35]) or Hispanic (OR 6.24 [1.01–38.51]) had increased risk of facial nerve palsy. Relative to children in the 4th income quartile, children in the 1st income quartile had increased risk of acute mastoiditis (OR 1.87 [1.15–3.03]) and subperiosteal abscess (OR 6.75 [2.22–20.56]). Children in the 2nd income quartile were less likely to receive ossicular chain surgery (OR 0.31 [0.13–0.72]). ConclusionDifferences pertaining to age, race, payer status, and socioeconomic status exist in the presentation and surgical management of children hospitalized with cholesteatoma. Older children are at increased risk of intracranial complications. Patients of Black and Hispanic race might have a higher risk of facial nerve palsy. Compared to children of higher income families, those from lower income families more frequently develop acute mastoiditis and subperiosteal abscess. Providers should be mindful of these risk factors when caring for children with cholesteatoma.