Preference for the closed technique in the management of cholesteatoma of the middle ear in children: a retrospective study of 215 consecutive patients treated over 10 years.
OBJECTIVE
To evaluate clinical data, extensions, residual and recurrent lesion rates, and functional results in cases of cholesteatoma in pediatric patients.


METHODS
A retrospective study at a single tertiary care center over a decade.


METHODS
In 199 children (mean age 9.6 years), 215 cholesteatomas were treated surgically, and the children were followed up for an average of 70 months (range 25-118 months).


METHODS
Therapeutic and rehabilitative surgical procedures were done, using either a closed technique (CT) or an open technique: tympanoplasty in open technique (TOT), radical mastoidectomy (RM), or Rambo's technique)


METHODS
Surgical findings, residual and recurrent lesions rate, and hearing assessment.


RESULTS
The first surgical procedure was CT in 88% of cases, TOT in 10%, RM and Rambo's technique in 1%. Two operations were done in 61.8% of children; 21% had three operations and 4.5% had four. Residual lesions were observed in 21.5% of all children, 32.8% in those undergoing a planned second look. Recurrence rate was 9.8%. Surprisingly, residual and recurrent lesion rates were higher after TOT (23.8% and 19%) than after CT (20.5%, 8.9%), but TOT-treated children had much more extensive lesions. A speech reception threshold (SRT) <30 dB hearing loss (HL) was achieved in 63.7% of patients, and normal hearing was obtained in 12.1%; SRT was significantly better after CT (mean 26.7 dB) than after TOT (mean 37.4 dB), after type II (mean 27 dB) than after type III (35 dB). A high-frequency pure-tone hearing loss >10 dB was uncommon (7.6%).


CONCLUSIONS
These results support the continued use of CT in most cases of cholesteatoma in children in developed countries.
Ear, Nose and Throat Department, University Hospital of Bordeaux, France.
V
V
Darrouzet
J Y
JY
Duclos
D
D
Portmann
J P
JP
Bebear
D000293:Adolescent; D001299:Audiometry; D001844:Bone Conduction; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008416:Mastoid / Q000601:surgery*; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D013069:Speech Reception Threshold Test; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000379:methods*