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Aggressiveness of pediatric cholesteatoma. Do we have an evidence?
Zareen A Lynrah1, Jaimanti Bakshi1, Naresh K Panda1
1Department of Otolaryngology, Head & Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Pediatric cholesteatoma patients often present with granulation tissue, leading to more aggressive disease and higher recurrence rates compared to adults. Adult patients more frequently have cholesteatoma alone, with similar complication risks but equivocal hearing outcomes in both groups.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Skull Base Surgery
Background:
- Cholesteatoma, a destructive эпителиальное образование in the middle ear, affects both pediatric and adult populations.
- Understanding differences in clinical presentation, disease extent, and outcomes between pediatric and adult cholesteatoma is crucial for effective management.
- Chronic suppurative otitis media with cholesteatoma presents unique challenges in younger patients.
Purpose of the Study:
- To prospectively compare pediatric and adult patients with cholesteatoma regarding clinical presentation, disease extent, and treatment outcomes.
- To evaluate the impact of granulation tissue in pediatric cholesteatoma cases.
- To assess the correlation between disease grading, complications, and recurrence rates in different age groups.
Main Methods:
- Prospective study of 60 patients with unsafe chronic suppurative otitis media with cholesteatoma, divided into pediatric (30) and adult (30) groups.
- Detailed clinical examination, high-resolution computed tomography (CT) of the temporal bone, and a novel disease grading system were employed.
- All patients underwent canal wall down mastoidectomy, with postoperative evaluation for symptom resolution, hearing, and cavity issues.
Main Results:
- Granulation tissue with cholesteatoma was significantly more prevalent in children (p < 0.01), while adults predominantly had cholesteatoma alone.
- A strong correlation was observed between radiological and surgical findings.
- Higher disease grades correlated with increased risk of complications and recurrence (p < 0.05). Recurrence was significantly higher in children (p < 0.05), with similar complication rates in both groups. Hearing improvement was equivocal.
Conclusions:
- The presence of granulation tissue in pediatric cholesteatoma contributes to more aggressive disease and a higher recurrence rate.
- Disease grading is a valuable predictor of complications and recurrence in cholesteatoma management.
- While complications are similar, pediatric cholesteatoma requires specific attention due to its aggressive nature and higher recidivism potential.
Abstract:
To compare pediatric and adult patients, affected by cholesteatoma for the clinical presentation, disease extent and final outcome. This is a prospective study in which 60 cases of unsafe chronic suppurative otitis media with cholesteatoma were included. These cases were divided into two groups of 30 cases each on the basis of age. All patients were subjected to detailed clinical examination. A high resolution computed tomography of the temporal bone was done in all the cases. An innovative grading system was devised to grade the disease. The patients were subjected to canal wall down mastoidectomy and were evaluated postoperatively for resolution of the symptoms, hearing and cavity problems. Granulation tissue along with cholesteatoma was more common among children (p < 0.01), whereas cholesteatoma alone was more common among adults. There was excellent correlation between the radiological and surgical findings. It was seen that higher the grade of the disease, the greater was the risk of complications and recidivism (p < 0.05). Recidivism was significantly higher in children (p < 0.05) whereas complications were equally common in both the groups. Hearing improvement was equivocal in both groups. Presence of granulation tissue along with cholesteatoma in children causes more aggressive disease with higher recidivism rate.
