Intact canal wall mastoidectomy with tympanoplasty for cholesteatoma in children

OBJECTIVE/HYPOTHESIS: Cases of cholesteatoma in pediatric patients were reviewed to determine which factors influence the outcome of surgical treatment. Cholesteatoma is considered a more aggressive disease in children than in adults. The outcomes of intact canal wall (ICW) mastoidectomy and canal wall down (CWD) mastoidectomy were assessed, as comparisons of different surgical technique. STUDY DESIGN: A retrospective analysis of all cases of pediatric cholesteatoma treated at a single institution by the senior author (P.R.L.) over a period of 11 years was conducted. METHODS: Patient information was collected from an otology database, patient records, and audiology files. RESULTS: Sixty-six patients, aged 10 months to 18 years, were treated and followed for an average of 37.7 months (range 12.2 months to 12.5 y). ICW mastoidectomy with tympanoplasty was the primary surgical treatment in 41 patients. Nineteen percent had residual disease at a planned second stage surgery and 22% developed recurrent cholesteatoma for a total recidivism rate of 41%. A SRT of less than 30 dB HL was achieved in 75% of these patients. Seventeen patients underwent CWD mastoidectomy with tympanoplasty initially. Two patients (12%) had residual cholesteatoma found at a planned second state procedure, and no recurrent cholesteatoma was encountered. Seventy-two percent maintained a SRT of less than 30 dB HL. CONCLUSIONS: These results support the continued use of ICW mastoidectomy with tympanoplasty for pediatric cholesteatoma. If planned second stage surgery is necessary, the long-term results of an ear with useful hearing and few problems with chronic medical care are gratifying. For reasons of anatomy or in an only hearing ear, CWD mastoidectomy with tympanoplasty provides a safe ear and good hearing results. Mastoid cavity care must be maintained indefinitely in many cases.