Innovations in paediatric cholesteatoma surgery

The management of children with cholesteatoma has advanced over the course of this century thanks to innovations in surgical instrumentation and other aspects of care. A narrative review giving a perspective on the contributions of advances such as dedicated equipment for endoscopic ear surgery including powered instrumentation and KTP laser, and other areas including CT and MRI imaging, is provided. These have helped raise the standard of care from achieving a "safe dry ear" potentially with a mastoid cavity, to less invasive approaches that can deliver a functionally and cosmetically normal ear in many cases. Areas in need of further innovative approaches persist in the control of residual and recurrent cholesteatoma and hearing loss. Surgeons are advised to be wary of over-reliance on the use of untested hypothetical mechanisms when considering the adoption of new technologies, such as Eustachian tube balloon dilatation. Improved standards for data collection, analysis and reporting will help ensure that efficacious and cost-effective innovations are adopted in future to further improve outcomes from the care of paediatric cholesteatoma.