Pediatric one-stage cholesteatoma surgery: long term results

The long-term results of pediatric cholesteatoma are dispersed and then is no consensus on operation methods and on factors affecting outcome of surge ry. We analyzed the independently evaluated long-term results and possible reasons for recholesteatoma. Eighty-four consecutive pediatric (age <16 yea rs) cholesteatoma operations were undertaken in the Helsinki University Cen tral Hospital ENT Department. The operations were not staged; all mastoids were obliterated and bony ear canals reconstructed without open cavities. T he pre- and perioperative and annual control data were recorded in a databa se. The last control was independently performed (J.S.) with an average fol low-up of 4.8 years and 87% attendance. The total recholesteatoma rate was 29% (24/84), and it was not dependent on the size of cholesteatoma, mastoid status, cholesteatoma in the window niches or stapedial erosion. A retract ion process developed in 25% (21/84) of the ears and 42% (9/21) of these tu rned into retraction pocket cholesteatomas as late as 13 years postoperativ ely. Retractions and postoperative discharge, especially in combination, pr edisposed to recholesteatoma. Of the healed ears, 37% became atelectatic. H earing was maintained on the preoperative level. Reduced middle ear and att ic ventilation led to retractions, and atelectasis and a tendency to discha rge accelerated the process. Pitfalls in mastoid obliteration and attic rec onstruction and the failure to create new ventilation routes were important reasons for recholesteatoma. (C) 1999 Elsevier Science Ireland Ltd. All ri ghts reserved.