Problems of pediatric cholesteatoma and countermeasures

Abstract

We report a retrospective study of 35 children, aged 3 to 15 years, with 37 affected ears who underwent surgery for cholesteatoma between 1985 and 1998 in our clinic. The patients were followed for an average of 56 months (range 7 to 147 months). Patient data was collected from clinical records, audiology files, and radiological records in order to reexamine problems of pediatric cholesteatoma and consider the countermeasures. Twenty nine (85%) of ears with acquired cholesteatoma had a history of otitis media. Purulent otorrhea was observed in 71% of the affected ears at the first medical examination, 4 cases were complicated by acute mastoiditis. Sonotubometry showed eustachian tube dysfunction in 10 (91%) of affected 11 ears. Among patients who underwent open & reconstructive tympanoplasty combined with mastoid obliteration during the early study period (1985-1992), the total recurrence rate was 39%, including residual cholesteatoma in 8% (n=1) of 13 ears, and recurrent cholesteatoma in 31% (n=4). The recurrence rate decreased to 22% (residual cholesteatoma in 0 %, and recurrent cholesteatoma in 22%, n=2), in 9 patients who underwent intact canal wall tympanoplasty during the latter period (1993-1998). Postoperative hearing tests showed that modified type III and N tympanoplasties using artificial ossicular chain prostheses appeared to be superior to tympanoplasties using the residual ossicle. Mastoidectomy did not influence development the temporal bone in terms of length. We conclude that infection and eustachian tube malfunction might be involved in rapid and wide spread of pediatric cholesteatoma and contribute to the high recurrence rate. Therefore, appropriate antibiotics should be given and sufficient cleaning of the ear should be carried out, especially before and during the surgery. Although the surgical approach should be tailored to the particular features of each case, the one-stage operation using the canal-up technique seems to be advantageous.