title: Long-term Results of Endoscopically Assisted Pediatric Cholesteatoma Surgery.
abstract: OBJECTIVE
  Routine endoscopic examination during primary surgery decreased the rate of residual cholesteatoma to 18% in our early experience. Based on this, we stopped performing routine second-look surgery in children who were endoscopically free of cholesteatoma at the end of primary surgery. We sought to investigate if second-look procedures after endoscopic-assisted surgery could safely be performed only in children at a high risk of residual disease (extensive inflammation, spontaneously ruptured or fragmented cholesteatoma, residual disease intentionally left).
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary pediatric otolaryngology practice.
  
  
  METHODS
  Children aged 1 to 16 years who were treated for cholesteatoma over 15-year period by a single surgeon. Extent of disease and endoscopic findings were compared with rates of residual disease. Time to diagnosis of residual disease and prognostic factors were analyzed.
  
  
  RESULTS
  Forty-two children underwent endoscopically assisted middle ear surgery for cholesteatoma. Of 42 children, 7 (17%) had additional disease found by endoscopy that was missed by microscopy alone. Twelve children at high risk had second looks; 5 (42%) had residual disease. Of 30 children, 2 (7%) presented with macroscopically evident residual cholesteatoma after no planned second look on office follow-up and subsequently underwent reoperation and were cured.
  
  
  CONCLUSIONS
  Selective second-look surgery in high-risk children did not adversely affect outcome as compared with the low-risk group. Cholesteatoma was identified endoscopically in 7 of 42 (17%) children thought to be microscopically free of disease at initial surgery. The endoscope may aid in visualization of difficult middle ear recesses when used to complement microscopy. Further investigation with multicenter data is needed.
authors.affiliation: Departments of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA david.sarcu@tuhs.temple.edu.
authors.forename: David
authors.initials: D
authors.lastname: Sarcu
authors.affiliation: Departments of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA Department of Pediatrics, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Glenn
authors.initials: G
authors.lastname: Isaacson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D013506:Otologic Surgical Procedures / Q000379:methods*; D024162:Second-Look Surgery / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: cholesteatoma; chronic otitis media; endoscopy; middle ear surgery; minimally invasive surgery; pediatric otology