INTACT CANAL WALL MASTOIDECTOMY WITH TYMPANOPLASTY FOR CHOLESTEATOMA IN CHILDREN

Objective/Hypothesis: Cases of cholesteatoma in pediatric patients wer e reviewed to determine which factors influence the outcome of surgica l treatment. Cholesteatoma is considered a more aggressive disease in children than in adults. The outcomes of intact canal wall (ICW) masto idectomy and canal wall down (CWD) mastoidectomy were assessed, as com parisons of different surgical technique. Study Design: A retrospectiv e analysis of all cases of pediatric cholesteatoma treated at a single institution by the senior author (P.R.L.) over a period of 11 years w as conducted. Methods: Patient information was collected hom an otolog y database, patient records, and audiology files, Results: Sixty six p atients, aged 10 months to 18 years, were treated and followed for an average of 37.7 months (range 12.2 months to 12. 5 y), ICW mastoidecto my with tympanoplasty was the primary surgical treatment in 41 patient s, Nineteen percent had residual disease at a planned second stage sur gery and 22% developed recurrent cholesteatoma for a total recidivism rate of 41%, A SRT of less than 30 dB HL was achieved in 75% of these patients. Seventeen patients underwent CWD mastoidectomy with tympanop lasty initially. Two patients (12%) had residual cholesteatoma found a t a planned second state procedure, and no recurrent cholesteatoma was encountered Seventy-two percent maintained a SRT of less than 30 dB H L, Conclusions: These results support the continued use of ICW mastoid ectomy with tympanoplasty for pediatric cholesteatoma. if planned seco nd stage surgery is necessary, the long-term results of an ear with us eful hearing and few problems with chronic medical care are gratifying . For reasons of anatomy or in an only hearing ear, CWD mastoidectomy with tympanoplasty provides a safe ear and good hearing results. Masto id cavity care must be maintained indefinitely in many cases.