Endoscopic management of acquired paediatric cholesteatoma: a retrospective cohort study

Background: Acquired cholesteatoma is considered a more aggressive disease in children than in adults. Traditional microscopic techniques, particularly canal wall down mastoidectomy, have been reported to have reduced rates of recidivism but require long-term management. Endoscopic ear surgery (EES) is increasingly being used in cholesteatoma surgery. The objective of this paper is to determine the rate and risk factors for recidivism in paediatric patients undergoing EES for acquired cholesteatoma. Methods: A retrospective chart review of a database of paediatric patients treated for acquired cholesteatoma by EES was conducted to determine outcomes of EES for acquired paediatric cholesteatoma and identify factors associated with recidivism. Results: Forty-nine ears with an average age at time of primary surgery of 11.2 years were included. Thirty ears were male. Overall recidivism rate was 34.7% with a mean follow-up period of 30.6 months (range, 12.2-74.6 months). The residual disease rate was 32.7%. The only statistically significant predictor of residual disease on multivariate analysis was epitympanic disease. Mesotympanic and retrotympanic diseases correlate with very low residual disease rates. In total, 10.2% of patients were found to have retraction of the tympanic membrane without cholesteatoma formation and 1 patient had recurrent cholesteatoma. Thirtyone patients underwent ossicular chain reconstruction with significantly improved post-treatment hearing thresholds with a mean improvement of 16 dB. Conclusions: EES for acquired paediatric cholesteatoma has very low recidivism rates in the mesotympanum and retrotympanum whereas the highest recidivism rates were seen with attic cholesteatoma. Despite this recidivism, the audiological outcomes are excellent.