A multivariate analysis of the factors predicting hearing outcome after surgery for cholesteatoma in children.
OBJECTIVE
To explore factors influencing hearing outcomes in children treated by canal wall up (CWU) and canal wall down (CWD) mastoid surgery.


METHODS
Retrospective cohort study including three units in Bristol and Bath, UK. Ninety consecutive children underwent cholesteatoma mastoid surgery, with the first procedure between 1998 and 2001; minimum follow up was three disease-free years.


RESULTS
The CWU and CWD cohorts significantly differed in pre-operative stage and hearing. After disease eradication, air conduction (AC) thresholds changed by +4.0 dB (95 per cent confidence intervals (95% CI) -2.0, 10.1) in the CWD group and -5.3 dB (95% CI -9.3, 1.3) in the CWU group (p=0.029). Using multiple linear regression to account for cohort differences, AC thresholds were increased by: pre-operative AC threshold (p<0.0001), initial ossicular stage (p=0.013), and CWD-surgery (p=0.005).


CONCLUSIONS
Disease-free hearing was better with CWU-surgery, less initial ossicular damage, and better pre-operative hearing. Worse initial disease increased the likelihood of CWD surgery. Wider use of ossiculoplasty in the CWU cohort (51 per cent vs 5 per cent) may partially explain the superior results.
Chadha
N K
NK
Department of Ear, Nose and Throat Surgery, Royal United Hospital, Bath, UK. neil@chadhanet.com
Jardine
A
A
Owens
D
D
Gillett
S
S
Robinson
P J
PJ
Maw
A R
AR
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000150:complications / Q000601:surgery*; D015331:Cohort Studies; D004739:England; D005260:Female; D006309:Hearing; D006311:Hearing Disorders / Q000209:etiology; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D015999:Multivariate Analysis; D013506:Otologic Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome