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Tympano-ossicular allografts for cholesteatoma in children
A G Schilder1, P J Govaerts, T Somers
1University Department of Otolaryngology-Head and Neck Surgery, Sint Augustinus Hospital, University of Antwerp, Antwerp-Wilrijk, Belgium.
Insights
This study found that using tympano-ossicular allografts for cholesteatoma surgery in children is effective and safe. The technique provides good anatomical results and acceptable hearing outcomes, with a low rate of residual or recurrent disease.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Engineering
Background:
- Cholesteatoma in children requires surgical intervention.
- The canal wall up approach with tympano-ossicular allograft reconstruction is a common technique.
- Staged procedures are often employed for cholesteatoma management.
Purpose of the Study:
- To evaluate the long-term outcomes of canal wall up cholesteatoma surgery with tympano-ossicular allograft reconstruction in children.
- To assess the rates of residual and recurrent cholesteatoma after staged procedures.
- To analyze the anatomical and functional (audiological) results of this surgical technique.
Main Methods:
- Retrospective chart review of 103 pediatric patients with cholesteatoma.
- Surgical treatment involved a canal wall up approach and immediate tympano-ossicular allograft reconstruction.
- A second-stage operation was performed after approximately 1 year for assessment.
- Postoperative follow-up averaged 4.5 years.
Main Results:
- Residual cholesteatoma was found in 28 children, and 20 developed recurrent disease.
- 11 children required more than two operations for recurrent cholesteatoma.
- An intact graft was present in 79 children.
- Median bone-conduction thresholds remained stable, while air-conduction thresholds improved in 50% of cases.
Conclusions:
- The tympano-ossicular allograft technique is effective and safe for pediatric cholesteatoma surgery.
- The approach yields good anatomical results and acceptable functional hearing outcomes.
- Staged procedures help manage residual and recurrent cholesteatoma effectively.
Abstract:
At the Sint Augustinus Hospital, Antwerp, Belgium, all children with cholesteatoma are operated by a canal wall up approach and immediate reconstruction with a tympano-ossicular allograft. In the majority of the cases, a second stage is performed after 1 year. This paper presents the results of a retrospective review of the charts of 103 consecutive children treated between 1979 and 1995. The mean patient age was 10 years and the mean postoperative follow-up was 4.5 years. In 28 children residual cholesteatoma was found at the second stage operation and 20 developed recurrent cholesteatoma in the course of time. So far no residual cholesteatoma surfaced after the staged procedure, but 11 children needed more than two operations to control recurrent disease. An intact, trouble-free graft was present in 79 children at the latest follow-up. The median postoperative bone-conduction thresholds were equal to the preoperative thresholds. The median postoperative air-conduction thresholds improved in 50% of the cases, remained unchanged in 25%, and deteriorated in 25% of the cases. It is concluded that the tympano-ossicular allograft technique is effective and safe and offers good anatomical and acceptable functional results.
