Middle-ear cholesteatoma in children--an Indian perspective

A study of the clinical presentation of acquired aural cholesteatoma in 51 Indian children is presented. An attempt has been made to assess the impact of this chronic ear disease in terms of the morbidity it incurs upon the paediatric population. The preponderance of bilateral presentation in cholesteatomatous otitis media (24.5 per cent) and the associated sensorineural or mixed hearing loss (in 25.4 per cent of the ears) is emphasized, to reflect the alarming audiological disability in the afflicted child. An attempt has been made to correlate the otoscopic profile with the extent of disease, osteitic damage and co-existing complications. It was noted that, in Indian children, mesotympanic choleasteatoma was more often associated with large defects of the pars tensa (viz. marginal, subtotal and total perforations--54.4 per cent) than with postero-superior retraction pockets (37.2 per cent) or purely attic defects (7.8 per cent). Further analysis revealed this common otoscopic presentation to be a more active process, occurring in predominantly cellular mastoids and associated with extensive disease. Based on this study, a more aggressive canal down tympanomastoid approach is advocated for children presenting with this otoscopic profile.