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One-stage revision surgery for pediatric cholesteatoma: long-term results and comparison with primary surgery
1Department of Otorhinolaryngology, Institute for Clinical Medicine, University of Tromso, N 9037, Tromso, Norway.
Insights
Revision surgery for pediatric cholesteatoma has a 38% recurrence rate, similar to primary surgery. Recurrence is linked to ear discharge and poor ventilation, highlighting the need for experienced surgeons and new techniques.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Outcomes
Background:
- Pediatric cholesteatoma frequently recurs after primary surgery.
- Limited data exists on the long-term outcomes of revision surgery for pediatric cholesteatoma.
Purpose of the Study:
- To evaluate the long-term results of revision surgery for pediatric cholesteatoma.
- To compare the outcomes of revision surgery with those of primary surgery.
Main Methods:
- A consecutive series of 42 pediatric cholesteatoma revision operations were analyzed.
- All surgeries involved mastoid obliteration and bony ear canal reconstruction.
- Independent evaluation with an average follow-up of 4.3 years.
Main Results:
- The recurrence rate for revision surgery was 38%, with retraction developing in 38% of ears.
- Postoperative discharge and poor middle ear ventilation correlated with recurrence.
- Experienced surgeons showed a lower recurrence rate; hearing improved in non-recurrent revision cases.
Conclusions:
- Recurrence patterns in revision surgery mirror those of primary surgery.
- Pediatric cholesteatoma surgery requires experienced surgeons to minimize recurrence.
- Current surgical methods lead to significant recurrence; novel techniques for improved aeration are needed.
Objective:
Few studies report on revision surgery for pediatric cholesteatoma, even if most studies of primary surgery show high recurrence rates. We present independently evaluated long-term results of revision surgery and compare the results with those of primary surgery.
Methods:
The series consisted of 42 consecutive pediatric (age <16 years) cholesteatoma revision operations in the Helsinki University ENT Department. The primary and revision surgery was non-staged, all mastoids were obliterated and the bony ear canals were reconstructed. The preoperative, surgical and annual control data were recorded in a database. The last control was independently performed (J.S.) with an average follow-up of 4.3 years and 87% attendance.
Results:
The recurrence rate for revision operations was 38%. A retraction process developed in 38% of the ears and 67% of these retractions turned into active cholesteatomas. There was a non-significant difference for these figures as compared with primary surgery. Postoperative discharge and poor middle ear ventilation were associated with recurrence. The following factors showed significant differences between primary and revision surgery: increased number of bare facial nerve in the revision group, lower recurrence rate for experienced surgeons (as for both groups together) and improved hearing results for ears without recurrence in the revision group.
Conclusions:
Recurrent disease after revision surgery appears either in the attic or in the mesotympanum, or develops from a retraction pocket in a similar manner as was seen in patients receiving primary surgery. Recurrence is associated with discharging and poorly ventilated ears. Pediatric cholesteatoma surgery should be done or be supervised by experienced surgeons. The present operation methods result in many recurrences after primary and revision surgery. New surgical methods are needed to create additional aeration pathways to the epitympanum in order to improve middle ear aeration and to prevent some of the retractions.