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Updated: Jan 24, 2026
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Tympanomastoidectomy for Cholesteatoma in Children: Audiometric Results
Sharon Tzelnick1,2, Dan Yaniv1,2, Eyal Raveh3,2
11 Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
Insights
Pediatric cholesteatoma surgery via tympanomastoidectomy improves hearing outcomes, particularly when ossicular reconstruction is performed. These hearing gains are stable over time, offering valuable insights for surgical planning.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Audiology
Background:
- Cholesteatoma in children often requires surgical intervention.
- Tympanomastoidectomy is a common surgical approach.
- Understanding hearing outcomes is crucial for pediatric otologic care.
Purpose of the Study:
- To investigate audiometric outcomes following tympanomastoidectomy in pediatric cholesteatoma patients.
- To identify factors influencing hearing results after surgery.
- To assess the impact of ossicular reconstruction on hearing.
Main Methods:
- Retrospective cohort study of 100 children (104 surgeries) undergoing canal wall-up tympanomastoidectomy.
- Audiometric evaluation (PTA, ABG) before and after surgery.
- Comparison of outcomes with and without ossicular reconstruction.
Main Results:
- Significant improvement in Pure Tone Average - Air Bone Gap (PTA-ABG) post-surgery (27.5 to 20.2 dB).
- 73% of patients achieved PTA-ABG < 20 dB postoperatively, up from 34% preoperatively.
- Ossicular reconstruction significantly improved PTA-ABG at all follow-up points.
Conclusions:
- Hearing outcomes after pediatric cholesteatoma surgery are variable but generally improve.
- Ossicular reconstruction is a key factor in enhancing audiometric results.
- Surgical improvements in hearing are sustained over the follow-up period.
Objectives:
The aim of this study was to investigate the audiometric outcomes of tympanomastoidectomy in children with cholesteatoma and to evaluate factors that may affect outcomes.
Methods:
A retrospective cohort study was conducted. All pediatric patients diagnosed with cholesteatoma who underwent primary canal wall-up tympanomastoidectomy with or without ossicular reconstruction from 2009 to 2016 at a tertiary university-affiliated pediatric medical center were included. Pure tone average (PTA) and air-bone gap (ABG) at 0.5, 1, 2, and 4 kHz were compared before and after surgery.
Results:
The cohort included 100 children (104 tympanomastoidectomies) of mean age 10.35 ± 3.6 years. The mean duration of follow-up was 35.4 ± 24.1 months. At surgery, 22 patients (21.2%) had intact ossicular chains, and 82 (78.8%) had ossicular discontinuity. Fifty-three patients (51%) underwent ossicular reconstruction, either partial (34 patients [64.1%]) or total (19 patients [35.8%]). In comparison with preoperative audiometry, there was a statistically significant improvement in PTA-ABG at the first postoperative examination (27.5 ± 12.7 vs 21.1 ± 11.1 dB, P = .001) and at the end of follow-up (20.2 ± 12.7 dB, P = .003) . Overall, values of less than 20 dB were measured in 34% of patients preoperatively and 73% postoperatively. On subgroup analysis, in patients who underwent any ossicular reconstruction, PTA-ABG was significantly improved relative to the preoperative value (28.1 ± 14.7 dB) at both the first (19.1 ± 11.9 dB, P = .006) and last (22.4 ± 15.1 dB, P = .011) audiometry examinations.
Conclusions:
Hearing outcomes after pediatric cholesteatoma surgery are diverse and related to several factors. The authors found that ossicular reconstruction improves audiometric outcomes, and the changes remain stable over time.
Level Of Evidence:
IIB.
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