Pediatric one-stage cholesteatoma surgery: long term results

Abstract

The long-term results of pediatric cholesteatoma are dispersed and there is no consensus on operation methods and on factors affecting outcome of surgery. We analyzed the independently evaluated long-term results and possible reasons for recholesteatoma. Eighty-four consecutive pediatric (age < 16 years) cholesteatoma operations were undertaken in the Helsinki University Central Hospital ENT Department. The operations were not staged; all mastoids were obliterated and bony ear canals reconstructed without open cavities. The pre- and perioperative and annual control data were recorded in a database. The last control was independently performed (J.S.) with an average follow-up of 4.8 years and 87% attendance. The total recholesteatoma rate was 29% (24/84), and it was not dependent on the size of cholesteatoma, mastoid status, cholesteatoma in the window niches or stapedial erosion. A retraction process developed in 25% (21/84) of the ears and 42% (9/21) of these turned into retraction pocket cholesteatomas as late as 13 years postoperatively. Retractions and postoperative discharge, especially in combination, predisposed to recholesteatoma. Of the healed ears, 37% became atelectatic. Hearing was maintained on the preoperative level. Reduced middle ear and attic ventilation led to retractions, and atelectasis and a tendency to discharge accelerated the process. Pitfalls in mastoid obliteration and attic reconstruction and the failure to create new ventilation routes were important reasons for recholesteatoma.