Aggressiveness of Pediatric Cholesteatoma. Do We Have an Evidence?

Abstract

To compare pediatric and adult patients, affected by cholesteatoma for the clinical presentation, disease extent and final outcome. This is a prospective study in which 60 cases of unsafe chronic suppurative otitis media with cholesteatoma were included. These cases were divided into two groups of 30 cases each on the basis of age. All patients were subjected to detailed clinical examination. A high resolution computed tomography of the temporal bone was done in all the cases. An innovative grading system was devised to grade the disease. The patients were subjected to canal wall down mastoidectomy and were evaluated postoperatively for resolution of the symptoms, hearing and cavity problems. Granulation tissue along with cholesteatoma was more common among children (p < 0.01), whereas cholesteatoma alone was more common among adults. There was excellent correlation between the radiological and surgical findings. It was seen that higher the grade of the disease, the greater was the risk of complications and recidivism (p < 0.05). Recidivism was significantly higher in children (p < 0.05) whereas complications were equally common in both the groups. Hearing improvement was equivocal in both groups. Presence of granulation tissue along with cholesteatoma in children causes more aggressive disease with higher recidivism rate.

Cholesteatoma in children and adults: are there really any differences?

“…We found significant differences between childhood cholesteatoma and adult disease, the former of which was more extensive and destructive at the time of surgery. These results support the findings of other studies that have suggested cholesteatoma in children to be more aggressive 16 , 20 , 21 . Although many studies have reviewed children and adult populations with cholesteatoma, a limited number of studies have directly compared these two groups.…”

“…found increased neuro-otological symptoms in adults compared to children 14 . Regarding complications, while some authors have reported fewer complications in children, 15 others have not found any statistical differences between the two groups 16 . Mallet et al .…”

“…14 Regarding complications, while some authors have reported fewer complications in children, 15 others have not found any statistical differences between the two groups. 16 Mallet et al reported more aggressive cholesteatoma in children based on increased levels of the monoclonal antibody MIB1, which is thought to be responsible for epithelial hyperproliferation and hence more aggressive disease. 17 This was further confirmed by Dornelles et al, who reported an increased number of inflammatory markers, including cluster of differentiation 31, and matrix metalloproteinases 2 and 9, in childhood cholesteatoma compared to adult disease.…”

The disease recurrence rate after the canal wall up or canal wall down technique in adults

“…It is essential to clarify that the operation technique is not the only factor influencing the risk of cholesteatoma recidivism. In addition, this risk is affected by the extent of the disease (especially mastoid extension), ossicular chain disruption, cholesteatoma location and preoperative ear discharge . However, it should be emphasized that all studies investigating the aforementioned risk factors included only children or studied a population consisting of both children and adults .…”

Utility of vestibular testing and new technologies in a complex cholesteatoma

“…Pediatric cholesteatoma is known to be more aggressive than cholesteatoma acquired later in age [1]. The incidence of recidivist disease in pediatric cholesteatoma is much higher than in adult patients [2]. Moreover, the incidence of cholesteatoma in children with cleft palate is reported higher (1.8-9.2%) than those without (0.3-0.6%) [3,4].…”