title: Extensive acquired cholesteatoma in children: when the penny drops.
abstract: OBJECTIVE
  To determine the factors associated with the diagnosis of acquired cholesteatoma (AC) in children, we performed a retrospective chart review at a tertiary care center.
  
  
  METHODS
  We reviewed children with a diagnosis of AC that extended beyond the mesotympanum in the presence of a nonintact tympanic membrane who underwent surgical treatment over a 14-year period.
  
  
  RESULTS
  There were 116 children (78 male, 38 female) between 3 and 18 years of age (mean, 9.5 years). Their average period of management in a specialist otolaryngology clinic before the diagnosis of cholesteatoma was made was 3.2 years, and 68% of the children had previously undergone insertion of tympanostomy tubes. Symptoms and signs included chronic otorrhea (59%), recurrent acute otitis media (58%), and conductive hearing loss (51%). The diagnosis of AC was eventually made after office otoscopy (26%), temporal bone computed tomography (24%), or examination under anesthesia (17%). In 33% of children, the diagnosis was made only after surgical exploration of the middle ear and mastoid.
  
  
  CONCLUSIONS
  Our data underscore the importance of maintaining a high index of suspicion for AC in managing children with long-standing otologic symptoms, and considering otomicroscopy, computed tomographic scanning, or tympanomastoid exploration if medical treatment fails.
authors.affiliation: Department of Otolaryngology, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Craig W
authors.initials: CW
authors.lastname: Semple
authors.forename: Murali
authors.initials: M
authors.lastname: Mahadevan
authors.forename: Robert G
authors.initials: RG
authors.lastname: Berkowitz
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001301:Audiometry, Pure-Tone; D002648:Child; D002675:Child, Preschool; D002781:Cholesteatoma / Q000175:diagnosis* / Q000601:surgery; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D010033:Otitis Media / Q000175:diagnosis; D011859:Radiography; D012189:Retrospective Studies; D013701:Temporal Bone / Q000000981:diagnostic imaging