title: Can long-term hearing preservation be expected in children following cholesteatoma surgery? Results from a 14-year-long study of atticotomy-limited mastoidectomy with cartilage reconstruction.
abstract: OBJECTIVE
  Following cholesteatoma surgery, effective long-term hearing preservation in children is difficult and is not typically expected. Hence, long-term data on hearing outcomes are lacking. The aim of this study was to analyze long-term hearing outcomes in children following cholesteatoma surgery.
  
  
  METHODS
  For this study, 49 ears in 47 children (≤16 years) with acquired cholesteatomas following atticotomy-limited mastoidectomy with cartilage reconstruction (inside-out approach) during 1986-2010 were included. Pre- and post-operative recidivism-free audiometric results were compared. Hearing success was defined as a post-operative air conduction (AC) threshold of ≤30 dB (serviceable hearing). Logistic regression analyses were used to evaluate potential prognostic factors that independently contributed to the prediction of hearing success. These factors included stapes condition, pre-operative AC threshold, ossicular chain integrity, disease severity, age, and gender.
  
  
  RESULTS
  The mean duration of follow-up was 14.2 years. The post-operative AC (33.55 ± 15.42 dB) and air-bone gap (17.88 ± 12.94 dB) were significantly improved compared with the pre-operative AC (42.90 ± 16.47 dB, p < 0.001) and air-bone gap (30.23 ± 13.68 dB, p < 0.001). The probability of hearing success following surgery (40.8%) was significantly higher than prior to surgery (24.5%, p = 0.008). Multivariate logistic regression analyses revealed a statistically significant correlation between hearing success and stapes integrity only (p = 0.005).
  
  
  CONCLUSIONS
  This study provides important information on effective long-term hearing preservation over a mean follow-up of 14 years. In addition, stapes destruction is an independent negative prognostic determinant of achieving hearing success. The prediction model in this study provides otologists with useful pre-operative information to inform patients and parents on expected hearing outcomes and may be useful for post-operative observations.
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Chin-Lung
authors.initials: CL
authors.lastname: Kuo
authors.forename: An-Suey
authors.initials: AS
authors.lastname: Shiao
authors.forename: Wen-Huei
authors.initials: WH
authors.lastname: Liao
authors.forename: Ching-Yin
authors.initials: CY
authors.lastname: Ho
authors.forename: Chiang-Feng
authors.initials: CF
authors.lastname: Lien
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001299:Audiometry; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008416:Mastoid / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000379:methods*