Treatment of cholesteatoma in children

Abstract

We studied retrospectively 28 cases of cholesteatoma in children whose ages were 3 to 13 years old. All had undergone surgery between 1989 and 1995. The intact canal wall technique was the predominant method used in the initial operation, with long term goals of an anatomically normal and infection-free ear. Cholesteatoma was found postoperatively in 15 cases and was considered to be residual in 6 cases and recurrent in 9. The residual cholesteatoma was relatively uncommon and usually removable in an exploratory second operation. Our findings showed that the intact canal wall technique was the best initial operation if two-stage surgery was planned. Avoidance of a retraction pocket, which tends to progress to a recurrent cholesteatoma, is important to successful treatment.

Paediatric small cavity mastoid surgery: second look tympanotomy

“…Following ICWM for childhood cholesteatoma residual disease is recognised as occurring in between 30 and 70% of cases [5][6][7] being most frequently found in the posterior mesotympanum and next most frequently in the epitympanum. This is not surprising as these are the regions most difficult to access, particularly as the posterior canal wall is retained and limits access to the oval window niche and sinus tympani.…”

“…Following ICWM it is accepted that second look exploration of the middle ear and mastoid is necessary particularly for children where the occurrence of residual disease varies between 30 and 70% [5][6][7]. The commonest sites for residual disease are the posterior mesotympanum and epitympanum [8,9].…”

Canal Wall Window Tympanomastoidectomy

“…The recurrence of cholesteatoma, usually as tiny pearls, was consistent with reported recurrence rates in pediatric patients in whom cholesteatoma seems to be a more formidable condition than in the adult. 4–9 At the time of chart review, no patient was in need of further operation, although third‐look surgery had been utilized in select patients. Three patients had required conversion to canal wall down procedures, although in one patient the rationale was partly for unfortunate social circumstances.…”