Long-term Results of Pediatric Cholesteatoma Surgery Using Canal-Wall-Down Approach with Primary Obliteration: 5-Year Observational Study

Abstract

Objectives:

Present the results of a 5-year longitudinal study in a pediatric population undergoing cholesteatoma surgery using a canal wall down approach with obliteration.

Methods:

Prospective longitudinal study in a district general hospital from 1999 to 2013.46 children (<16 years) with cholesteatoma were included. Outcome measurements were: (1) residual, recurrence, and recidivist cholesteatoma rates at 5 years postsurgery; (2) postoperative hearing; (3) postoperative waterproofing of the ear; (4) number of subsequent ear surgeries required.

Results:

Using Kaplan-Meier analysis, the residual cholesteatoma rate at 5-years post-surgery was 6.7% at a rate of 20.9 per 1000 years of child follow-up (95% confidence interval: 7.8-55.6), representing 4 cases of residual cholesteatoma and no recurrences. No children experienced otorrhea at 5 years and the rate of definitive waterproofing was 94.8%. There was a reoperation rate of 18.3% (n = 11) at 5 years, which included planned ossiculoplasty. Regarding hearing, of the data available (n = 17), 12 children (70.6%) preserved maintained their hearing (change between –10 to =10 dB), 1 child (5.9%) had hearing gain (>10 dB), and 3 children (17.6%) had hearing reduction at 12 months postoperation. Six out of 17 children (35.3%) had a postoperative hearing level of ≤30 dB.

Conclusions:

The use of a canal wall down approach with obliteration of the mastoid cavity to surgically treat cholesteatoma is safe in pediatric populations and results in a low recurrence rate and high rate of a trouble-free ear in the long term.