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Risk Factors of Recurrence in Pediatric Congenital Cholesteatoma

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Objective:

To examine the risk factors of recurrence in pediatric congenital cholesteatoma.

Study Design:

Retrospective chart review.

Setting:

University hospital.Patients:

Sixty-seven patients having tympanic type of congenital cholesteatoma under 15-years old at surgery.


Interventions:

Canal wall-up tympanomastoidectomy (n = 30) or transcanal atticotomy/tympanoplasty (n = 37) was performed depending on cholesteatoma extension, 16 of which were followed by second-look surgery. Preoperative computed tomography (CT) before second-look surgery or follow-up CT was performed to detect residual recurrence 1 year after the surgery. Cholesteatoma found at the second surgery was also included in the recurrence. All patients had no recurrent cholesteatoma at the last follow-up (median, 61 mo after surgery).

Main Outcome Measures:

Possible predictive factors were compared between the groups.Results:

Residual cholesteatoma and retraction cholesteatoma occurred in 21 and 6%, respectively. There was no significant difference in age, sex, and type of cholesteatoma (open or closed) between the groups; however, Potsic stage and status of stapes involvement were more advanced in the residual cholesteatoma group. All residual lesions could be detected by follow-up CT or by second-look surgery. All of four retraction cholesteatoma patients were male, young at the surgery and in stage IV.
Conclusion:

Recurrence mostly occurred as residual cholesteatoma, suggesting that CT is recommended as a follow-up tool for congenital cholesteatoma. Advanced lesions had the risk of residual cholesteatoma, suggesting that complete removal of epithelium is important. Although rare, young advanced-stage patients had risk of retraction cholesteatoma and therefore normal mucosa should be preserved as much as possible for these patients.
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Keywords: Pediatric cholesteatoma; Residual; Retraction cholesteatoma

Document Type: Research Article

Affiliations: 1: Department of Otolaryngology Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 2: Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan

Publication date: December 1, 2017

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