Learning Objectives: To analyze the differences in the prevalence of cholesteatoma growth patterns between children below and over 12 years of age. We also aim to study the effect of age on the observed alterations in the CLE.
Introduction: Some controversy still exists about the pathogenesis of cholesteatoma in children. Classical definitions of congenital cholesteatoma are being debated and the study of cholesteatoma based on age can be useful in improving our knowledge of this disease.
Methods: In a cross-sectional study, videotoscopy data of 148 pediatric patients were analyzed for cholesteatoma growth patterns and contralateral ear (CLE) alterations. The children were divided into two groups: 1) Group 1 comprising 67 patients, under 12 years of age and 2) Group 2 comprising 81 patients, 12 years or older.
Results: We found that 6 out of the 7 patients with anterior epitympanic cholesteatoma (AEC) belonged to group 1. In group 1, 43.3% of the patients were posterior mesotympanic (PMC), 19.4% were posterior epitympanic (PEC), 17.9% had two patterns of cholesteatomas and in 19.7% patients the growth pattern was undetermined. In group 2, 42% were PMC, 28.4% PEC, 18.5% both, and 11.1% of the patients had an undetermined growth pattern. There was no difference in the diagnosis of the principal ear between the two groups (p = 0.40). In the analysis of the CLE, in group 1, 35.7% of ears had pars tensa (PT) tympanic membrane (TM) retraction, 28.6% pars flaccida (PF) TM retraction, and 35.7% had both abnormalities. PT and PF retractions were present in 50% of children from group 2, and PT retraction only in 9.5% of this group. The differences between the two groups were statistically significant (p = 0.03). The CLEs of patients with AEC were normal.
Conclusion: The majority of AEC was found in children younger than 12 years of age and all displayed a normal CLE, suggesting a probable congenital origin. PMC was the most prevalent in both the study groups. The most prevalent CLE abnormalities in children over 12 years of age were PT and PF TM retraction together, suggesting that the PT retractions could evolve and block epitympanum aeration resulting in a PF retraction.
