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Updated: Jun 17, 2025
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Pediatric Cholesteatoma: An Overview of Presentation, Surgical Strategy and Outcomes of an Individualized Approach
H N Udayabhanu1, Piras Gianluca2, Chandra Agarwal Ashish3
1Department of ENT, Akash Institute of Medical Sciences and Research Center, Bengaluru, 562110 India.
Insights
Pediatric cholesteatoma (PC) surgery outcomes vary by technique. Canal wall down procedures showed lower residual/recurrent disease rates compared to canal wall up, emphasizing individualized treatment for better results.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Skull Base Surgery
Background:
- Pediatric cholesteatoma (PC) presents multifactorial etiology and aggressive growth.
- High rates of residual or recurrent disease necessitate optimized surgical management.
- Surgical techniques for PC remain a subject of debate.
Purpose of the Study:
- To document PC presentation and surgical approaches.
- To analyze outcomes, including residual/recurrence rates and hearing results.
- To compare the efficacy of different surgical techniques for PC.
Main Methods:
- A cross-sectional, record-based study of 618 PC cases operated between 1983 and 2015.
- Data collected on clinical and peri-operative findings.
- Analysis of surgical techniques: canal wall up (CWU), canal wall down (CWD), and others.
Main Results:
- Otorrhea (59.2%) and hearing loss (54.2%) were common symptoms.
- Residual and recurrence rates were 12.6% and 7.9%, respectively.
- Canal wall down (CWD) showed lower residual/recurrent disease rates than canal wall up (CWU).
Conclusions:
- Significant improvement in post-operative hearing was observed (mean air-bone gap improvement: 7.7 dB).
- Individualized surgical approaches are crucial for achieving disease-free outcomes in pediatric cholesteatoma.
- Surgical technique selection impacts residual/recurrent disease rates.
Abstract:
Pediatric cholesteatomas (PC) have multifactorial aetiology, spread aggressively and there are high chances of residual/ recurrent disease after treatment. The surgical technique to manage this entity has been debatable. This study was done to (i) enumerate the presentation of PC and the surgical techniques adopted (ii) analyse the outcomes viz., residual/ recurrence rates and hearing results. A cross sectional record based study was done on 618 cases of PC operated between 1983 and 2015, at a centre dedicated to otology and lateral skull base surgery. The data which was maintained on the basis of clinical and peri- operative findings was analysed. Otorrhea (59.2%) and hearing loss (54.2%) were the common symptoms. The surgeries done were: canal wall up (CWU) (44.3%), canal wall down (CWD) (41.1%), modified bondy's mastoidectomy (5.7%), radical mastoidectomy (4.9%), trans canal excision (1.8%) and subtotal petrosectomy (2.3%). The residual and recurrence rates were 12.6% and 7.9% respectively. A significant difference between the pre and post operative hearing was observed. The mean improvement in air bone gap was 7.7db. Residual/ recurrent disease were higher in CWU as compared to CWD group. The surgery should be individualised so that the patient remains disease free.
