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Pediatric Cholesteatoma Presenting as Persistent Otorrhea: A Case of Delayed Diagnosis Across Multiple ENT
And Elshani1, Lorent Sijarina1, Omar Alqaisi2
1Faculty of Medicine University of Prishtina Prishtina Kosovo.
Insights
Pediatric cholesteatoma, a middle ear disease, can cause rapid bone erosion and recur. Early diagnosis of this condition in children with ear discharge or hearing loss is vital for effective treatment.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Imaging
Background:
- Pediatric cholesteatoma is an aggressive middle ear condition causing progressive erosion of adjacent structures.
- It presents with faster bone destruction and higher recurrence rates in children compared to adults.
- Symptoms often mimic chronic otitis media, potentially delaying diagnosis.
Purpose of the Study:
- To highlight the insidious presentation of pediatric cholesteatoma.
- To emphasize the importance of high suspicion for cholesteatoma in children with persistent ear symptoms.
- To underscore the role of imaging in diagnosis and surgical planning.
Main Methods:
- Case report of a 4-year-old boy with persistent otorrhea and conductive hearing loss.
- Otoscopic examination and high-resolution computed tomography (CT) for diagnosis.
- Surgical intervention via canal wall-up mastoidectomy with tympanoplasty.
Main Results:
- CT revealed soft-tissue density and scutum erosion in the middle ear.
- Intraoperative findings confirmed cholesteatoma with partial ossicular erosion.
- The patient underwent successful surgical removal.
Conclusions:
- Chronic otorrhea and unilateral hearing loss in children may indicate destructive middle ear disease, not just infection.
- Imaging is critical for diagnosing cholesteatoma, assessing bony erosion, and planning surgery.
- Early diagnosis and surgical intervention are essential to prevent complications and reduce recurrence in pediatric cholesteatoma.
Abstract:
Pediatric cholesteatoma is an aggressive but uncommon middle ear condition characterized by keratinizing squamous epithelium that can progressively erode adjacent structures. It is associated with faster bone destruction and higher recurrence rates in children than adults, and its symptoms often resemble chronic otitis media, which may delay diagnosis and treatment. A 4-year-old boy presented with persistent foul-smelling otorrhea from the left ear and conductive hearing loss. Otoscopic examination revealed a retracted tympanic membrane with a whitish epitympanic mass. High-resolution CT demonstrated soft-tissue density in the middle ear with scutum erosion. The patient underwent canal wall-up mastoidectomy with tympanoplasty, and intraoperative findings confirmed cholesteatoma with partial ossicular erosion. This case reflects the insidious clinical presentation of cholesteatoma and emphasizes that chronic otorrhea and unilateral hearing loss may indicate destructive middle ear disease rather than benign infection. Imaging plays a critical role in diagnosis and surgical planning, particularly in detecting bony erosion and disease extent. Maintaining a high index of suspicion for cholesteatoma in children with persistent discharge or unexplained conductive hearing loss is essential. Early diagnosis and timely surgical intervention are crucial to prevent irreversible complications and reduce recurrence risk.
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