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Problems in diagnosis and treatment of cholesteatoma in children
M Mitrović1, K Haralampiev, M Dzinić
1ENT Clinic, Military Medical Academy, Belgrade, Yugoslavia.
Insights
Pediatric cholesteatoma surgery shows a 31% recurrence rate, significantly higher than in adults. Surgical techniques included combined approach tympanoplasty and radical tympanomastoidectomy, with varied hearing outcomes.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Research
Background:
- Cholesteatoma, a skin cyst in the middle ear, affects children with varying locations and surgical challenges.
- Understanding pediatric cholesteatoma treatment outcomes is crucial for improving patient care.
Purpose of the Study:
- To analyze surgical treatment outcomes for pediatric cholesteatoma.
- To compare recurrence rates in children versus adults.
Main Methods:
- A retrospective clinical study of 56 children (aged 3-14 years) with cholesteatoma over six years.
- Surgical interventions included combined approach tympanoplasty (intact canal wall technique) and radical tympanomastoidectomy.
- Ossicular chain reconstruction was performed in 59% of cases.
Main Results:
- Cholesteatoma involved the attic, middle ear, or mastoid in all cases, with 50% extending to the mastoid.
- Hearing improved in 45% of patients, remained unchanged in 48%, and slightly worsened in 7%.
- Recurrence rate was 31% in children, compared to 15% in a previous adult study.
Conclusions:
- Pediatric cholesteatoma exhibits a higher recurrence rate than in adults.
- Surgical management requires careful consideration of technique and ossicular reconstruction for optimal hearing outcomes.
- Further research is needed to understand and reduce recurrence in pediatric cholesteatoma.
Abstract:
Our clinical study includes 56 cases of cholesteatoma in children aged 3-14 years, treated in a 6-year period. Cholesteatoma was localized in attic (6 cases), in middle ear (6 cases), in attic plus middle ear (16 cases) and in attic + middle ear + mastoid (28 cases or 50% of the total number). In the surgical treatment combined approach tympanoplasty (intact canal wall technique) was used in 76.8%, radical tympanomastoidectomy in 16.1%, and other techniques in 7.1%. Intact ossicular chain was found in 25%. Reconstruction of the ossicular chain (including autograft, homograft and allograft material) was done in 59%, and the remaining 16% were treated by classic radical surgery. Hearing results: unchanged, 48%; improved, 45%; slightly worsened, 7%; and no dead ear. Recurrency in 31% is considerably higher as compared to 15% in adults found in another comparable study by us.
