title: Soft-wall reconstruction of the canal wall with retrograde bone work for pediatric cholesteatoma: Long-term results.
abstract: OBJECTIVE
  To retrospectively evaluate the long-term results of surgery for retrograde bone work, using soft-wall reconstruction of the canal wall, for pediatric cholesteatoma.
  
  
  METHODS
  We retrospectively evaluated a series of 25 consecutive ears of 24 patients who were ≤16 years of age. All children underwent cholesteatoma surgery between October 2002 and August 2008. The type of cholesteatoma, the length of follow-up, the incidence of residual and recurrent cholesteatoma, postoperative hearing results, and the form of the reconstructed external canal wall and tympanic membrane were assessed.
  
  
  RESULTS
  There were 21 males and 3 females. The procedure was performed on both ears of one patient who had bilateral congenital cholesteatoma (CC). At the initial surgery, 16 cases (64%) had CC and nine (36%) had acquired cholesteatoma (AC). The mean age at surgery was 8.2 years and 10.4 years for CC and AC cases, respectively. The mean postoperative follow-up period after the initial surgery was 90 months for CC cases and 108 months for AC cases. Cholesteatoma recurrence occurred for 6% and 56% of cases with CC and AC, respectively. Successful serviceable hearing was achieved for 93.8% with CC and 100% with AC. Cases with inadequate hearing after surgery were characterized by disease extension to the mastoid and the protympanum. The long-term forms of the reconstructed external canal wall changed depending on their middle ear aeration. Some cases of tympanic membrane perforation and otitis media with effusion were occurred during the follow-up period.
  
  
  CONCLUSIONS
  Overall, the retrograde approach with soft-wall reconstruction of the canal wall achieved a low recurrence rate for cholesteatoma and good hearing outcomes during long-term follow-up for the pediatric case. However, in cases with eustachian tube dysfunction and/or cholesteatoma involving the protympanum, the hearing outcomes were less favorable.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan. Electronic address: miyakohatano@gmail.com.
authors.forename: Miyako
authors.initials: M
authors.lastname: Hatano
authors.affiliation: Department of Pediatric Otolaryngology, Jichi Medical University, Tochigi Pediatric Medical Center, Tochigi, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ito
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sugimoto
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Noda
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hasegawa
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Yoshizaki
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D004424:Ear Canal / Q000601:surgery; D004432:Ear, Middle / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013506:Otologic Surgical Procedures / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies
keywords: Cholesteatoma surgery; Middle ear; Retrograde approach