Pediatric Cholesteatoma: Factors Affecting Recurrence Rates and Hearing Outcomes

Abstract

Objective : Children with cholesteatoma have been reported to have higher rates of recurrence compared to adults. Clinical factors affecting the rate of disease recurrence and ultimate hearing outcomes were analyzed. Methods : Children diagnosed with cholesteatoma between April 1988 and May 2014 were identified. Medical records were reviewed to determine risk factors for disease recurrence and assess the hearing outcome. Results : One hundred and twenty-two children had sufficient data available for inclusion in our study. Three suffered bilateral disease allowing for 125 patient ears to be analyzed. Of these, 67/125 (53.6%) had recurrence after one surgery with a median time to recurrence of 9 months. There was a mean of 2.5 operations per patient. Five-year cholesteatoma free survival rate was 86.29%. Age (8.04 vs. 8.67 yrs old, p =0.36) and origin (congenital vs. acquired cholesteatoma) (54.8% vs. 53.7%, p =1) did not differ in outcomes. Epitympanic and oval window involvement resulted in a significantly higher recurrence rate (64.5% vs. 37.5%, p =0.0053 and 67.3% vs 45.3%, p =0.0178). Children with recurrence demonstrated more extensive disease with a higher number of middle ear sub-sites involved (3.67 vs. 2.82 areas involved, p =0.0061). Most importantly, children whose disease recurred had worse hearing outcomes with lower rates of air-bone gap closure (-5.319 dB vs. 6.351 dB, p =0.0082). Conclusion : While age was not a factor, pediatric patients with more extensive cholesteatoma are more likely to have recurrent disease and worse hearing outcomes.