Learning Objectives: The aim of this study is to retrospectively analyze the functional and hearing outcomes of surgery for cholesteatoma in pediatric population.
Study Design: Retrospective study
Setting: Gruppo Otologico, a quarternary referral center for Otology and Skull Base Surgery in Italy.
Materials & methods: A retrospective analysis is presented of 664 cases of cholesteatoma in pediatric population who were treated by surgery. The surgical approach was chosen according to the hearing loss, symptoms, status of tympanic membrane and radiological finding. Surgical procedures included Canal Wall Down mastoidectomies, Modified Bondy mastoidectomies, Canal Wall Up mastoidectomies, Radical mastoidectomies, revision surgeries and Subtotal Petrosectomies. In some of these patients additional procedure included Cochlear Implants or Bone-anchored hearing aids. Charts were analysed for type of cholesteatoma, surgical procedures, hearing results, recurrence and follow up.
Results: Charts of 664 patients were analysed. Of these patients, 39% underwent CWD surgery, 38% CWU surgery, 4.9% CWD with Bondy's technique, 4.3% radical CWD, 0.75% subtotal petrosectomy and 13% of patients underwent a revision tympanoplasty. For long-term functional and hearing outcomes, 552 patients with a follow-up of > 1 year were analyzed separately. Our experience shows an incidence of recurrent cholesteatoma of 19% during 10 years of follow up. In most of these cases CWU procedure was converted into a CWD mastoidectomy. Hearing results will be discussed upon presentation.
Conclusion: Surgery for cholesteatoma is especially challenging in a pediatric population because of the need for hearing preservation. Hence canal wall up mastoidectomy in a single or two stages should be the approach of choice in the pediatric population. The modified Bondy technique is a very useful hearing preservation procedure in limited epitympanic cholesteatomas. Radiological follow-up by DWI is mandatory in children for more than 5 years as recurrences can be seen even after 5 years.
