title: Bilateral cholesteatomas: the hospital for sick children experience.
abstract: OBJECTIVE
  The purpose of this article is to review the cases of bilateral cholesteatomas in a tertiary care pediatric otolaryngology department. We compare the presenting signs and symptoms and timing of ipsilateral and contralateral cholesteatomas and the initial audiometric findings.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON.
  
  
  RESULTS
  Twenty-two patients with bilateral cholesteatomas were accrued. Nine patients had bilateral congenital cholesteatomas and presented at a substantially younger age than those with acquired disease (average of 5 years, 9 months vs 11 years). Sixteen of the 22 patients were initially diagnosed with bilateral cholesteatomas. The majority of the remaining patients had evidence on initial assessment of contralateral middle ear disease. A particular subset of patients with severe disease requiring numerous bilateral revision surgeries was also identified. These patients also underwent revision surgery after a substantially shorter follow-up period.
  
  
  CONCLUSIONS
  Bilateral cholesteatomas in the pediatric population are extremely rare. Bilateral congenital cholesteatomas are more common in males, whereas bilateral acquired cholesteatomas are more common in females. The outcome is generally poor. A small subset with particularly aggressive disease requires many more bilateral revision surgeries at an earlier period when compared with the remainder of the group.
authors.affiliation: Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lin
authors.forename: Sam
authors.initials: S
authors.lastname: Daniel
authors.forename: Adrian
authors.initials: A
authors.lastname: James
authors.forename: Jacob
authors.initials: J
authors.lastname: Friedberg
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001299:Audiometry; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000151:congenital / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010033:Otitis Media / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome