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Updated: Jun 24, 2025
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Pediatric Cholesteatoma Follow-Up: Residual and Recurrence in 239 Cases with Over 5-Year Hindsight
François Simon1,2, Françoise Remangeon1,2, Natalie Loundon2
1Université Paris Cité, Paris, France.
Insights
Pediatric cholesteatoma requires long-term monitoring. This study suggests 5-year MRI follow-up for residual disease and 10-year clinical follow-up for recurrence detection in children.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Imaging
Background:
- Pediatric cholesteatoma is an aggressive condition necessitating extended evaluation.
- Optimal follow-up strategies are crucial for managing residual and recurrent disease in children.
Purpose of the Study:
- To determine the ideal duration for follow-up in pediatric cholesteatoma cases.
- To effectively detect residual and recurrent cholesteatoma in pediatric patients.
Main Methods:
- A cohort study involving patients with a minimum 5-year follow-up at a tertiary referral center.
- Analysis of medical history, surgical procedures, and follow-up data using Kaplan-Meier curves for residual and recurrence incidence.
Main Results:
- After the first surgery (S1), the maximum cumulative incidence of residual cholesteatoma was 45% at 74 months (39% at 3 years).
- Following a second surgery (S2), maximum residual incidence decreased to 21% at 62 months (16% at 3 years).
- Recurrence incidence after S1 reached a maximum of 21% at 98 months (16% at 5 years). Congenital cholesteatoma showed fewer residuals post-S1 but similar recurrence rates.
Conclusions:
- Recommend at least 5 years of MRI follow-up after the last surgery for residual disease.
- Recommend at least 10 years of clinical follow-up to detect recurrence in pediatric cholesteatoma.
Introduction:
Pediatric cholesteatoma is an aggressive disease which requires long-term evaluation to assess management strategies. The objective was to determine optimal follow-up duration in pediatric cholesteatoma to detect residual and recurrent diseases.
Methods:
This cohort study was set in a tertiary referral center. All consecutive patients with a minimum 5-year follow-up were included. Medical history, initial extension, surgical procedures, and follow-up were collected. The main outcome measure were Kaplan-Meier survival curves of residual and recurrence cumulative incidence.
Results:
Totally 239 ears with the first tympanoplasty between 2008 and 2014 were studied including 25% congenital. At first surgery (S1), mean age was 8.4 years and mean follow-up time 7.9 years. Mastoidectomy was performed in 69% and stapes was absent in 38% of cases. Notably, 83% (199 ears) had a second procedure (S2) of which 186 were planned. After S1, maximum cumulated incidence of residual was 45% [95%CI, 38%; 52%] at 74 months, with probability of residual of 39% at 3 years. After S2 (n = 199), maximum cumulated residual incidence was 21% [95%CI, 12%; 32%] at 62 months and 16% at 3 years. Concerning recurrence, maximum cumulated incidence after S1 (n = 239) was reached at 98 months with 21% [95%CI, 12%; 32%], 13% at 3 years and 16% at 5 years. Congenital disease had significantly less residuals after S1 (p = 0.02), but similar recurrence rate (p = 0.66) compared with acquired.
Conclusions And Relevance:
We recommend MRI follow-up of at least 5 years after the last surgery for residual disease and clinical follow-up of at least 10 years to detect recurrence.
Level Of Evidence:
4 Laryngoscope, 134:4789-4798, 2024.
