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Updated: Jun 18, 2025
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Follow-up strategies in pediatric cholesteatoma: a systematic review
Giulia Molinari1,2,3, Marella Reale4,5, Andrea Albera1,6
1Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy.
Insights
This systematic review found that post-operative follow-up strategies for pediatric cholesteatoma surgery are highly varied. The research highlights the need for standardized approaches in evaluating outcomes for young patients after cholesteatoma removal.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Imaging
Background:
- Cholesteatoma is a skin condition that can develop in the middle ear.
- Surgical intervention is common for pediatric cholesteatoma.
- Standardized post-operative follow-up is crucial for monitoring recurrence and complications.
Purpose of the Study:
- To systematically review the literature on pediatric patients surgically treated for cholesteatoma.
- To describe and analyze the post-operative follow-up strategies employed in these cases.
Main Methods:
- A systematic review adhering to PRISMA guidelines was performed.
- Searches were conducted in PubMed, Scopus, and Google Scholar for English-language studies.
- Included studies focused on pediatric cholesteatoma patients (≤18 years) undergoing primary or revision surgery with specific follow-up data.
Main Results:
- Nineteen papers (2000-2023) involving 1319 pediatric patients were analyzed.
- Mean follow-up was 4.4 years; clinical evaluations often used otomicroscopy.
- Radiological follow-up varied, with MRI most common, often combined with CT scans; second-look surgery was reported in 74% of studies.
Conclusions:
- Significant heterogeneity exists in the post-operative follow-up strategies for pediatric cholesteatoma surgery.
- Variations were noted in both the timing and types of investigations used.
- This highlights a need for more consistent follow-up protocols in pediatric cholesteatoma management.
Purpose:
The aim of this article was to systematically review the literature on the pediatric population surgically treated for cholesteatoma and describe the applied post-operative follow-up strategies.
Methods:
A systematic review was conducted following the Primary Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement recommendations. After running the selected search string in PubMed, Scopus and Google Scholar, studies in English, reporting on surgically treated pediatric cholesteatoma patients (age younger or equal to 18 year-old) were retrieved. Both primary and revision cholesteatoma surgeries were included. Articles lacking specific data on post-surgical follow-up and case series with less than 10 patients were excluded.
Results:
Nineteen papers, published between 2000 and 2023, were included for final analysis. Fourteen studies were retrospective and five prospective, for a total of 1319 patients and 1349 operated ears. Male to female ratio was 1.8:1, with a mean age at surgery of 10.4 years (range 1-18). The mean length of the follow-up after surgery was 4.4 ± 1.7 years (range 1-6.9). Clinical follow-up was detailed in 9 studies (47%) with otomicroscopy being the most common evaluation. In most articles (n = 8, 50%), MRI alone was utilized for radiological follow-up, while in 3 studies (19%), CT scans were employed exclusively. In 5 studies (31%), MRI was combined with CT scans. The timing of radiological investigations varied widely (ranging from 6 months to 3 years). A second-look strategy was reported in 14 studies (74%).
Conclusion:
This systematic review highlights the heterogeneity of the follow-up strategies applied to pediatric patients after cholesteatoma surgery, both in terms of timing and types of investigations.
