Pediatric Cholesteatoma: Factors Affecting Recurrence Rates and Hearing Outcomes 

Authors

  • Philip A. Gaudreau Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
  • McKenzie Tolan George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20052, USA
  • Allana Daniels Princeton University, Princeton, NJ 08544, USA
  • Brian K. Reilly Children’s National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010, USA
  • George Zalzal Children’s National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010, USA
  • Diego Preciado Children’s National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010, USA

DOI:

https://doi.org/10.12970/2308-7978.2017.05.06

Abstract

 Objective: Children with cholesteatoma have been reported to have higher rates of recurrence compared to adults. Clinical factors affecting the rate of disease recurrence and ultimate hearing outcomes were analyzed. Methods: Children diagnosed with cholesteatoma between April 1988 and May 2014 were identified. Medical records were reviewed to determine risk factors for disease recurrence and assess the hearing outcome. Results: One hundred and twenty-two children had sufficient data available for inclusion in our study. Three suffered bilateral disease allowing for 125 patient ears to be analyzed. Of these, 67/125 (53.6%) had recurrence after one surgery with a median time to recurrence of 9 months. There was a mean of 2.5 operations per patient. Five-year cholesteatoma free survival rate was 86.29%. Age (8.04 vs. 8.67 yrs old, p=0.36) and origin (congenital vs. acquired cholesteatoma) (54.8% vs. 53.7%, p=1) did not differ in outcomes. Epitympanic and oval window involvement resulted in a significantly higher recurrence rate (64.5% vs. 37.5%, p=0.0053 and 67.3% vs 45.3%, p=0.0178). Children with recurrence demonstrated more extensive disease with a higher number of middle ear sub-sites involved (3.67 vs. 2.82 areas involved, p=0.0061). Most importantly, children whose disease recurred had worse hearing outcomes with lower rates of air-bone gap closure (-5.319 dB vs. 6.351 dB, p=0.0082). Conclusion: While age was not a factor, pediatric patients with more extensive cholesteatoma are more likely to have recurrent disease and worse hearing outcomes.

References


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Published

2017-01-09

Issue

Vol. 5 (2017)

Section

Articles