Pediatric Cholesteatoma Aggressiveness; A Comparative Study of Predictive Factors and Recurrence Rate

Objective: The optimal surgical treatment for pediatric cholesteatoma is controversial. Management decisions including intact canal wall versus open cavity techniques continue to be debated. In an attempt to clarify this issue, we conducted a retrospective analysis of our experience with cholesteatoma cases presenting in pediatric population. Material and Method: Retrospective review was conducted on all children younger than 18 years of age and had cholesteatoma, between 2010 and 2013. Inclusion and exclusion criteria were specified. The children were divided into canal wall down (CWD) and canal wall up (CWU) mastoidectomies. The two groups were then compared regarding their age at presentation, clinical presentation, microscopic examination, radiological grading, intra operative findings, and postoperative outcomes, and compared with international recurrence rate figures. Results: We had total of four CWD & seven CWU mastoidectomies. CWD children were an average of 6 years of age, and had more aggressive disease at presentation with attic erosion in 75% of the cases. Granulation tissues with eroded ossicles were present in almost all the cases. While, CWU children had a longer history of offensive ear discharge, and presented with retraction pocket in 43% of the cases. There was no significant difference in the recurrence rate in CWD and CWU groups (25% & 28.6% respectively). Conclusion: Treatment of pediatric cholesteatoma should be individualized. The choice between CWU & CWD can be judged by several factors in patient history and through a thorough clinical ear examination. CWU procedure is an adequate surgical option for treating most acquired and congenital cholesteatomas, preventing disease recurrence, and maintaining good hearing outcomes, and CWD mastoidectomy chosen for patients with recurrent or more extensive disease.