title: Acquired cholesteatoma in children: clinical features and surgical outcome.
abstract: OBJECTIVE
  In general, cholesteatoma tends to recur more frequently in children than in adults. This has been suggested to be due to immature Eustachian tube function, underdeveloped mastoid air cells, and subsequent repetitive otitis media in children. This study was undertaken to determine the characteristics of acquired cholesteatoma in children by comparison with that in adults.
  
  
  METHODS
  We retrospectively evaluated 42 children with acquired cholesteatoma (males, 38; females, 4; age range, 3-15 years) using medical records from January 1999 to December 2009 at the Department of Otolaryngology, Niigata University Hospital. The extent of disease was classified according to the Classification and Staging of cholesteatoma proposed by the Japan Otological Society in 2010.
  
  
  RESULTS
  No major differences in stage classification were observed between children and adults. In children with pars flaccida-type cholesteatoma, the epithelium tended to invade from the attic to the mastoid cavity and mesotympanum. In contrast, adult patients with invasion to the mesotympanum were fewer. The rate of disappearance of the stapes superstructure was almost the same in children and in adults. The destruction of the superstructure of the stapes was more common in pars tensa type than pars flaccida type; so it was dependent on the pathology. Postoperative hearing levels were better in children, even in those with widespread lesions. However, the recurrence rate was significantly higher in children.
  
  
  CONCLUSIONS
  Acquired cholesteatoma in children showed a wider invasion, and the recurrence rates were higher than that in adults. For patients with a widespread lesion and severe destruction of the ossicles, a two-stage surgery is recommended.
authors.affiliation: Department of Otolaryngology-Head and Neck surgery, Faculty of Medicine, Niigata University, Japan. Electronic address: yukam@med.niigata-u.ac.jp.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Morita
authors.affiliation: Department of Otolaryngology-Head and Neck surgery, Faculty of Medicine, Niigata University, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Otolaryngology-Head and Neck surgery, Faculty of Medicine, Niigata University, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Oshima
authors.affiliation: Department of Otolaryngology-Head and Neck surgery, Faculty of Medicine, Niigata University, Japan.
authors.forename: Kuniyuki
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Otolaryngology-Head and Neck surgery, Faculty of Medicine, Niigata University, Japan.
authors.forename: Sugata
authors.initials: S
authors.lastname: Takahashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001299:Audiometry; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000000981:diagnostic imaging / Q000254:growth & development*; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013199:Stapes; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000379:methods*
keywords: Acquired cholesteatoma; Hearing results; Mastoid development; Stage; Surgical treatment