Risk Factors of Recurrence in Pediatric Congenital Cholesteatoma. Issue 10 (December 2017)

• Record Type: Journal Article
• Authors: Morita, Yuka; Takahashi, Kuniyuki; Izumi, Shuji; Kubota, Yamato; Ohshima, Shinsuke; Yamamoto, Yutaka; Takahashi, Sugata; Horii, Arata
• Is Part Of: Otology & neurotology. Volume 38:Issue 10(2017)
• Publication Date: 2017-12
• Subjects: Pediatric cholesteatoma -- Residual -- Retraction cholesteatoma; Otology -- Periodicals; Ear -- Diseases -- Periodicals; Skull base -- Surgery -- Periodicals; 617.8005
• DOI: 10.1097/MAO.0000000000001587
• Languages: English
• ISSNs: 1531-7129

Abstract

Abstract : Objective: To examine the risk factors of recurrence in pediatric congenital cholesteatoma. Study Design: Retrospective chart review. Setting: University hospital. Patients: Sixty-seven patients having tympanic type of congenital cholesteatoma under 15-years old at surgery. Interventions: Canal wall-up tympanomastoidectomy (n = 30) or transcanal atticotomy/tympanoplasty (n = 37) was performed depending on cholesteatoma extension, 16 of which were followed by second-look surgery. Preoperative computed tomography (CT) before second-look surgery or follow-up CT was performed to detect residual recurrence 1 year after the surgery. Cholesteatoma found at the second surgery was also included in the recurrence. All patients had no recurrent cholesteatoma at the last follow-up (median, 61 mo after surgery). Main Outcome Measures: Possible predictive factors were compared between the groups. Results: Residual cholesteatoma and retraction cholesteatoma occurred in 21 and 6%, respectively. There was no significant difference in age, sex, and type of cholesteatoma (open or closed) between the groups; however, Potsic stage and status of stapes involvement were more advanced in the residual cholesteatoma group. All residual lesions could be detected by follow-up CT or by second-look surgery. All of four retraction cholesteatoma patients were male, young at the surgery and in stage IV. Conclusion: Recurrence mostly occurred as residual cholesteatoma, suggesting that CT is recommended as a follow-up tool for congenital cholesteatoma. Advanced lesions had the risk of residual cholesteatoma, suggesting that complete removal of epithelium is important. Although rare, young advanced-stage patients had risk of retraction cholesteatoma and therefore normal mucosa should be preserved as much as possible for these patients.