title: Management of acquired cholesteatoma in children: a 15 year review in ENT service of CHNU de FANN Dakar.
abstract: OBJECTIVE
  To analyze the epidemiology, diagnosis, management and the prognosis of cholesteatoma of the middle ear in children.
  
  
  METHODS
  This was a retrospective study of 15 years (from 01 January 1995 to 31 December 2009) for patients aged 0-15 years admitted in ENT ward of FANN hospital for chronic otitis media complicated with cholesteatoma The parameters studied were epidemiology, clinical presentation, disease progression and management.
  
  
  RESULTS
  Sixty-six participants were included. We noted a slight male predominance with a sex ratio of 1.44. The average mean age was 10 years. Most patients presented with signs of complications (69.7%) and mastoiditis was the most common complication (63.6%). The otorrhea was noted in almost all patients: n = 64 (97%) and deafness in 49 patients (74, 2%). There was a slight predominance of cholesteatoma on the right side (51.5%). Schuller's view of the mastoid cells was done in 21.2% of patients (n = 14) and showed sclerotic mastoid air cells for all them. Eighty-two percent (82%) of patients presented with conductive hearing loss. A radical mastoidectomy was performed in 66.7% and modified radical mastoidectomy in 33.3% of cases. Mean follow-up was 6 months. Recurrence of cholesteatoma was noted in 13% of cases.
  
  
  CONCLUSIONS
  ENT ward of Hospital Fann is one of the two centers in Senegal where cholesteatoma of the middle ear are treated. This low number of cholesteatoma in children in a developing country is in relation to the fact that patients only present when complications develop: 70% of cases. The reason for this in our setting include insufficient human and manpower resources necessary for prompt management of the disease and also lack of awareness among the populace. In these settings we advocate canal wall down mastoidectomy (radical or modified radical) as the treatment of choice.
authors.affiliation: Service d'ORL et de Chirurgie Cervico-faciale, CHNU de FANN de Dakar, Senegal. Electronic address: evelynediom@yahoo.com.
authors.forename: E S
authors.initials: ES
authors.lastname: Diom
authors.forename: Z
authors.initials: Z
authors.lastname: Cisse
authors.forename: A
authors.initials: A
authors.lastname: Tall
authors.forename: M
authors.initials: M
authors.lastname: Ndiaye
authors.forename: E
authors.initials: E
authors.lastname: Pegbessou
authors.forename: I C
authors.initials: IC
authors.lastname: Ndiaye
authors.forename: B K
authors.initials: BK
authors.lastname: Diallo
authors.forename: R
authors.initials: R
authors.lastname: Diouf
authors.forename: E M
authors.initials: EM
authors.lastname: Diop
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001299:Audiometry / Q000379:methods; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D002908:Chronic Disease; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D006757:Hospital Units; D006801:Humans; D015994:Incidence; D008297:Male; D008991:Monitoring, Physiologic; D010033:Otitis Media / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D010034:Otitis Media with Effusion / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D013506:Otologic Surgical Procedures / Q000379:methods*; D038781:Otoscopy / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012675:Senegal / Q000453:epidemiology; D012720:Severity of Illness Index; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Children; Cholesteatoma; Middle ear