Cholesteatoma in cleft lip and palate: a population-based follow-up study of children after ventilation tubes.

OBJECTIVES/HYPOTHESIS To investigate the association of cleft conditions and the development of secondary cholesteatoma following middle ear ventilation tube insertion (MEVTI) in children. STUDY DESIGN A retrospective cohort study of all children born after 1980 who underwent at least one MEVTI in a Western Australian hospital from 1980 to 2009 using administrative health data. METHODS The timing and number of MEVTIs, adenoidectomy, type of cleft conditions and cholesteatoma were identified along with demographic variables. Flexible parametric proportional hazards models and hazard functions using age as a time scale were used to estimate the relative rate of developing cholesteatoma. RESULTS There were 56,949 children who underwent at least one MEVTI during the study period. There were 869 (1.5%) children who also had a diagnosis of a cleft condition. Overall, 594 (1.0%) children developed a secondary cholesteatoma. After taking length of follow-up into account, 6.9% (95% confidence interval [CI], 5.0-9.6) of children with cleft conditions developed cholesteatoma by 18 years of age compared to 1.5% (95% CI, 1.3-1.6) of children without cleft conditions. After adjusting for demographic and clinical variables, children with cleft conditions developed cholesteatoma 7.5 (95% CI, 3.8-18.2) times faster after first MEVTI compared to children without cleft conditions, although by the third MEVTI this difference was no longer statistically significant (P = .257). The rate of developing cholesteatoma in 2005 to 2009 was 0.5 (95% CI, 0.3-0.8) times that of 1980 to 1990. CONCLUSIONS Children with cleft conditions are at increased risk of developing cholesteatoma compared to other children who had one or two MEVTIs, although the overall rate of cholesteatoma is declining.