Acquired cholesteatoma in children: Strategies and medium-term results

Summary Objectives To assess paediatric cholesteatoma surgical management strategies, residual disease and recurrence rates and especially the medium-term auditory impact. Material and methods Retrospective study of 22 cases of acquired middle ear cholesteatoma selected from a series of 77 children under the age of 16 operated for cholesteatoma between 1st January 2000 and 31st December 2003 on the basis of the following criteria: first-line surgical management with postoperative follow-up greater than four years. Surgical strategies, preoperative and postoperative (at 1 year and at the final visit) audiograms and residual disease and recurrence rates were analysed. Results A canal wall up tympanoplasty was performed in 82% of cases as first-line procedure and a canal wall down tympanoplasty was performed in 32% of cases. Residual cholesteatoma was observed in 9% of cases and recurrent disease was observed in 18% of cases. The mean preoperative hearing loss was 26 dB with an air-bone gap of 23 dB with values of 26 dB and 20 dB respectively at the end of follow-up. Conclusion The majority of children were operated by two-stage canal wall up tympanoplasty. Long-term hearing results remained stable and close to preoperative values. The recurrence rate (residual disease and relapse) was low (27%), as reported in the literature.