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Updated: Dec 13, 2025
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Is pediatric cholesteatoma more aggressive in children than in adults? A comparative study using the EAONO/JOS
António Fontes Lima1, Filipa Carvalho Moreira1, Ana Sousa Menezes1
1Department of Otorhinolaryngology, Hospital de Braga, 4715, Braga, Portugal.
Insights
Pediatric cholesteatoma is more aggressive and extensive than adult cholesteatoma, often involving the supratubal recess and malleus. Age under 16 is a key risk factor for recurrence in chronic otitis media with cholesteatoma.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Imaging
Background:
- Chronic otitis media with cholesteatoma (COMC) can lead to severe complications, particularly in children.
- Pediatric COMC may exhibit more aggressive behavior and higher morbidity rates.
- The European Academy of Otology and Neurotology/Japan Otologic Society (EAONO/JOS) classification system aids in defining aggressive cholesteatoma.
Purpose of the Study:
- To compare cholesteatoma characteristics in pediatric versus adult patients.
- Utilize the EAONO/JOS staging system for comparative analysis.
- Identify age-related differences in cholesteatoma behavior and outcomes.
Main Methods:
- Retrospective analysis of 134 patients undergoing cholesteatoma surgery.
- Exclusion of congenital cholesteatoma, revision surgeries, and lost follow-ups.
- Division into pediatric (<16 years) and adult (>16 years) cohorts for comparison.
Main Results:
- Pediatric patients showed significantly higher extension to the supratubal recess.
- Malleus erosion and higher EAONO/JOS disease stages were more frequent in the pediatric group.
- Age under 16 was identified as an independent risk factor for disease relapse.
Conclusions:
- Cholesteatoma in pediatric patients demonstrates a more aggressive and extensive nature compared to adults.
- Younger age (<16 years) is a significant independent risk factor for cholesteatoma recurrence.
- The EAONO/JOS classification provides a framework for understanding these age-related differences.
Introduction:
chronic otitis media with cholesteatoma (COMC) is a serious condition that may cause severe complications. According to the literature, in pediatric patients this entity can have a more aggressive behavior, leading to higher rates of morbidity. Consensus regarding the definition of aggressive and extensive cholesteatoma was lacking until recently. European Academy of Otology and Neurotology/Japan Otologic Society (EAONO/JOS) proposed a classification and staging system which was highly accepted by a group of otology experts.
Objective:
to compare cholesteatoma characteristics between pediatric and adult patients using the EAONO/JOS stating system.
Material And Methods:
a retrospective analysis of the patients who underwent surgery for cholesteatoma treatment in a tertiary hospital was performed using EAONO/JOS classification. Congenital cholesteatoma, revision surgery, and follow-up losses were excluded. The patients were further divided into two cohorts: a pediatric group (<16 years old) and an adult group (>16 years old). The results were compared between them.
Results:
134 patients fulfilled the inclusion criteria, 27 were pediatric, and 107 adult patients. We found a significant difference in supratubal recess, with higher rates of extension to this location in the pediatric group. Also in the pediatric cohort, COMC was accompanied by malleus erosion in a higher frequency, with a significant difference from adults; it also presented in higher stages of the disease according to EAONO/JOS classification. We found no differences in hearing gain post-operatively. Moreover, we found that age younger than 16 years was an independent risk factor for relapse with time.
Discussion And Conclusions:
according to our data, cholesteatoma in pediatric age has a more aggressive and extensive nature than in adults, and age younger than 16-years-old is an independent risk factor for relapse.
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