Dealing with paediatric cholesteatoma: how we changed our management

We reviewed our series of surgeries for paediatric cholesteatoma to assess outcomes and functional results considering the extension of disease and surgical techniques. Between January 2003 and December 2009, 36 patients (range 6-14 years) were operated on for cholesteatoma. We considered the sites involved by the cholesteatoma (mastoid, antrum, attic, middle ear, Eustachian tube), surgical techniques used (intact canal wall, canal wall down) and how our habits changed over the years; moreover, we evaluated ossicular chain conditions and how we managed the ossiculoplasty. As outcomes, we considered the percentage of residual and recurrent cholesteatoma for each technique and hearing function (air bone gap closure, high frequencies bone conduction hearing loss) at follow-up. Intact canal wall was performed in 20 patients and canal wall down in 13 patients, in 9 as first surgery. In both groups, we observed improvement of the air bone gap; in the intact canal wall group, a residual cholesteatoma was observed in 6 patients whereas, during follow-up, 2 patients who underwent a canal wall down showed a recurrent cholesteatoma that was treated in an outpatient setting. Eradication of cholesteatoma and restoration of hearing function in paediatric patients present unique surgical challenges. Our experience shows an increased choice of intact canal wall over the years. Therefore, it is important for the surgeon to counsel parents about the probable need for multiple surgeries, especially if an intact canal wall mastoidectomy is performed.