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[Long-term results of cholesteatoma surgery in children]
1Servicio de ORL y Cirugía Funcional del Oído, Hospital de la Creu Roja, Barcelona.
Insights
Pediatric cholesteatoma surgery outcomes were analyzed, revealing radical mastoidoepitympanectomy had a 12.9% failure rate. This technique is currently favored for better anatomical-functional results in children.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Outcomes
Context:
- Pediatric cholesteatoma surgery presents challenges in achieving optimal anatomical and functional results.
- Long-term follow-up of surgical techniques is crucial for evaluating efficacy and recurrence rates.
Purpose:
- To statistically analyze the long-term results of different surgical techniques for pediatric cholesteatoma.
- To compare the pathological failure and hearing outcomes associated with radical mastoidoepitympanectomy, reconstructive techniques, and intact canal wall tympanoplasty (ICWT).
Summary:
- A 7-year follow-up of 57 pediatric cholesteatoma cases (ages 3-11) showed pathological failure rates of 12.9% for radical mastoidoepitympanectomy, 21% for reconstructive techniques, and 33% for ICWT.
- Cholesteatoma commonly affected the attic, mastoid, and middle ear, often involving ossicular chain destruction.
- Hearing results were better in 17.5% of cases, with hearing loss in 10.5%.
Impact:
- Radical mastoidoepitympanectomy is currently the most frequently used technique, associated with the lowest failure rate (12.9%) in this pediatric cohort.
- Findings guide the selection of surgical techniques to improve long-term outcomes in pediatric cholesteatoma management.
- Understanding failure rates and functional results informs surgical decision-making for pediatric cholesteatoma.
Abstract:
In the long-term results, a large percentage of failures of pediatric cholesteatoma surgery (recurrent and residual), as well with the open and closed (ICWT) techniques and motive for the low rates of functional results are a reflection for most authors about the best surgical technique for improving anatomical-functional results. A total of 57 cases of children's cholesteatoma (3-11 years) operated on in a five-year period (1983-1990) with follow-up surgery to 7 years was analyzed statistically. The location of the cholesteatoma in most cases was in the attic and mastoid (72%) with extension to middle ear in 77% and ossicular chain destruction in 80% of cases. In 54% of cases, radical mastoidoepitympanectomy was performed, in 40% mastoidectomy or attico-antrotomy with tympanoplasty and reconstruction of posterior wall with homologous and alloplastic materials, and only in 5.2%, intact canal wall tympanoplasty. Pathological failure (residual + recurrent cholesteatoma) occurred in 17.5% (12.9% with the radical mastoidepitympanectomy, 21% with the reconstructive techniques and 33% with ICWT). The hearing results were better in 17.5% of cases (average 20.2 dB) and hearing loss occurred in 10.5%. At the present time, in most cases the surgical technique used is radical mastoidoepitympanectomy (12.9% of failures).