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Acquired middle ear cholesteatoma in children with cleft palate: experience from 18 surgical cases
Vincenzo Vincenti1, Francesca Marra1, Barbara Bertoldi1
1Department of Clinical and Experimental Medicine, Unit of Audiology and Pediatric Otorhinolaryngology, University of Parma, Italy.
Insights
Surgical management of middle ear cholesteatoma in children with cleft palate showed good outcomes. Canal wall up mastoidectomy is often effective, with canal wall down mastoidectomy considered for extensive disease.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Genetics and Congenital Disorders
Background:
- Cleft palate is associated with an increased risk of middle ear disease, including acquired cholesteatoma.
- Surgical outcomes for middle ear cholesteatoma in this specific pediatric population are not well-defined.
Purpose of the Study:
- To review institutional surgical experience with middle ear cholesteatoma in children with cleft palate.
- To evaluate the efficacy and safety of different surgical techniques.
Main Methods:
- Retrospective analysis of 18 children with cleft palate and acquired middle ear cholesteatoma (2000-2007).
- Data collected included patient demographics, surgical history, cholesteatoma characteristics, and surgical techniques (canal wall up/down mastoidectomy, modified Bondy).
- Outcomes measured: cholesteatoma recurrence, mastoid cavity status, and hearing levels (air-bone gap).
Main Results:
- Follow-up averaged 8 years. Canal wall up mastoidectomy was performed in 12 children, with 16.6% residual and 16.6% recurrent cholesteatoma requiring conversion.
- Canal wall down mastoidectomy or modified Bondy technique in 6 children showed no recurrence, with one revision for granulation.
- Postoperative air-bone gap of 0-20dB achieved in 61.1% of patients; bone conduction remained unaffected.
Conclusions:
- Canal wall up mastoidectomy is a viable option for most pediatric cleft palate patients with middle ear cholesteatoma, offering low complication rates.
- Canal wall down mastoidectomy should be considered for extensive disease or contralateral retraction pockets.
- Modified Bondy procedure is effective for epitympanic cholesteatomas with intact ossicular systems; hearing preservation is achievable.
Objectives:
To review an institutional experience with the surgical management of middle ear cholesteatoma in children with cleft palate.
Materials And Methods:
We analyzed retrospectively 18 children diagnosed with cleft palate who underwent surgery for acquired middle ear cholesteatoma between 2000 and 2007. The following data were recorded: age, sex, history of ventilation tube insertion, status of the contralateral ear, cholesteatoma location and extension, and surgical technique involved. Cholesteatoma recidivism, stable mastoid cavity and hearing levels were the main outcomes measured.
Results:
Follow-up ranged from 5 to 12 years (mean 8 years). Twelve children underwent planned staged canal wall up mastoidectomy: a residual cholesteatoma was found and removed during the second-look procedure in 2 ears (16.6%); two children (16.6%) showed a recurrent cholesteatoma and required conversion to canal wall down mastoidectomy. A modified Bondy technique was chosen in two children with an epitympanic cholesteatoma with an intact tympano-ossicular system, while in the remaining four subjects a canal wall down mastoidectomy was performed because of an irreparable erosion of the postero-superior canal wall: no cases of recurrent cholesteatoma were observed in these 6 children; revision mastoidectomy was needed in one patient for cavity granulation. A postoperative air-bone gap result of 0-20dB was achieved in 11 children (61.1%); in 5 cases (27.7%) postoperative air-bone gap was between 21 and 30dB, while in 2 (11.1%) was >30dB. Bone conduction thresholds remained unaffected in all cases.
Conclusions:
Our results indicate that most cleft palate children with cholesteatoma can be managed with a canal wall up mastoidectomy with low complication rates. In extensive disease with large erosion of the canal wall as well in presence of a retraction pocket in the contralateral ear, a canal wall down mastoidectomy should be considered. In epitympanic cholesteatomas with an intact tympano-ossicular system and mesotympanum free of disease, the modified Bondy procedure is an effective surgical option. As in the general pediatric population, improvement or preservation of hearing can be obtained in most patients.
