Predictive Factors of Recurrence in Pediatric Cholesteatoma Surgery

OBJECTIVE: This study aims to analyze factors influencing the recurrence of acquired pediatric cholesteatoma that has impact on operative plan decision. PATIENTS AND METHODS: Retrospective review of 62 children (68 ears) with acquired middle ear cholesteatoma who underwent surgery from 1995 to 2006. Age distribution at initial operation ranged from 3 to 16 years with mean age of 11.2 years. Surgical removal of acquired cholesteatoma using ICWT (22%) or CWDT (78%) was performed. The median observation period was 30 months(±SD?). RESULTS: The recurrence rate was estimated at 22%. In univariate analysis, higher rate of recurrence was correlated with age, cholesteatoma extent, mucosa state, ossicular chain state and operative technique. When multivariate analysis was performed to verify the independent correlation of the above four variables, only ossicular chain state, mucosa state, and cholesteatoma extent remained associated with recurrence. CONCLUSION: Pediatric acquired cholesteatoma is known to be an aggressive disease associated with a higher rate of recurrence than adults. Thus, this disease should be managed as early as possible for better anatomic and hearing results. To define the best therapeutic strategy, it is necessary to consider many factors such as total eradication of the disease, preservation of auditory function, and predictable follow up period. This study shows that ossicular chain state, mucosa state and cholesteatoma extent were found to be independently associated with recurrence. For the final decision, all factors should be properly considered and analyzed. Department of Otorhinolaryngology, Head and Neck surgery; University Hospital Farhat Hached Sousse – Tunisia.