How long is long enough to follow up children after cholesteatoma surgery? A 29-year study

To identify an association between follow-up period and cholesteatoma recidivism.

Retrospective review.

From 1982 to 2011, we retrospectively screened a consecutive series of children (≤ 18 years) with acquired cholesteatomas after primary surgery. The cumulative recidivism rates were calculated using standard calculation methods and Kaplan-Meier survival analysis.

A total of 73 operations were performed on 71 patients. The mean age was 10.7 years, and the mean follow-up period was 15.4 years. The number of censored cases increased with the follow-up time. Sixty-four (88%) operations had a follow-up period of 5 years or longer, and 41 (56%) operations 15 years or longer. Cholesteatoma recidivism was observed in seven ears (five recurrent and two residual diseases). The mean detection time was 10.4 years (range 1.9-17.2 years). Five of the seven ears (71.4%) with recidivism were detected more than 10 years after surgery. The recidivism rate increased with the follow-up time. However, the rates at 5, 10, 15, 20, and 25 years as calculated by the standard calculation method (1.4%, 2.7%, 8.2%, 9.5% and 9.5%, respectively) were underestimated compared with that by Kaplan-Meier analysis (1.4%, 3.1%, 11.6%, 14.4% and 14.4%, respectively).

The Kaplan-Meier survival analysis method should be used when discussing recidivism rates, because the number of censored cases inevitably increases with observation time. Due to the late occurrence of recidivism and because the recidivism rate increases as time goes on, children should be periodically followed up for as long as possible.