One-stage revision surgery for pediatric cholesteatoma: long-term results and comparison with primary surgery

Objective: Few studies report on revision surgery for pediatric cholesteato ma, even if most studies of primary surgery show high recurrence rates. We present independently evaluated long-term results of revision surgery and c ompare the results with those of primary surgery. Methods: The series consi sted of 42 consecutive pediatric (age < 16 years) cholesteatoma revision op erations in the Helsinki University ENT Department. The primary and revisio n surgery was non-staged, all mastoids were obliterated and the bony ear ca nals were reconstructed. The preoperative, surgical and annual control data were recorded in a database. The last control was independently performed (J.S.) with an average follow-up of 4.3 years and 87% attendance. Results: The recurrence rate for revision operations was 38%. A retraction process d eveloped in 38% of the ears and 67% of these retractions turned into active cholesteatomas. There was a non-significant difference for these figures a s compared with primary surgery. Postoperative discharge and poor middle ea r ventilation were associated with recurrence. The following factors showed significant differences between primary and revision surgery: increased nu mber of bare facial nerve in the revision group, lower recurrence rate for experienced surgeons (as for both groups together) and improved hearing res ults for ears without recurrence in the revision group. Conclusions: Recurr ent disease after revision surgery appears either in the attic or in the me sotympanum, or develops from a retraction pocket in a similar manner as was seen in patients receiving primary surgery. Recurrence is associated with discharging and poorly ventilated ears. Pediatric cholesteatoma surgery sho uld be done or be supervised by experienced surgeons. The present operation methods result in many recurrences after primary and revision surgery. New surgical methods are needed to create additional aeration pathways to the epitympanum in order to improve middle ear aeration and to prevent some of the retractions. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved .