Comparison of congenital and acquired cholesteatomas in pediatric patients

Abstract

Objectives: This study aims to present clinical data and surgical results of patients with congenital cholesteatoma (CC) and acquired cholesteatoma (AC). Patients and Methods: Pediatric cholesteatoma patients who underwent tympanomastoid surgery between January 2008 and June 2015 were evaluated retrospectively. Demographic data, clinical symptoms, surgical and post-surgical findings were recorded. Mastoid development was evaluated with preoperative temporal bone computed tomography. Areas with cholesteatoma were mapped intraoperatively and cholesteatoma was staged. Intraoperative stapes superstructure deformation was assessed. Postoperative hearing results were compared according to air bone gap (ABG) values. Statistical analysis was made by Mann-Whitney U and Kruskal Wallis test. Results: We analyzed 60 patients (9 CC and 51 AC) under 16 years of age and followed at least six months. In the CC and AC groups, mean age was 6.1 and 10.4 years, and mean follow-up was 28 and 32 months, respectively. While CC group patients were generally asymptomatic, AC group patients were diagnosed with complaints of otorrhea, otalgia and hearing loss. Mastoid development was better in CC group patients (p<0.001). Intraoperatively, the AC mostly covered two or more regions while CC was mostly in one region. There was more deformity of stapes superstructure in AC group patients (p=0.019). Recurrence rates were similar for CC and AC groups and for different types of surgeries (p=0.128). Functional postoperative hearing (ABG ≤10dB) was 44.4% in the CC group and 25.4% in the AC group. Conclusion: The AC is more common than the CC, mastoid development is worse and ossicles are affected more. There are no significant differences in recurrence rates of applied surgeries. However, postoperative hearing results are better in patients who external ear canal preservation, which has an advantage of not causing more mastoidectomy cavity problems. With the main condition of completely removing pathology, these techniques can easily be preferred in cholesteatoma surgery.