Outcomes in Pediatric Cholesteatoma

Authors

Katherine M Miller
Yi-Chun Carol Liu
Jaqueline E Weinstein
Michael S Cohen
David H Chi
Samantha Anne

Publication Date

1-1-2025

Journal

Otolaryngology–Head and Neck Surgery

DOI

10.1002/ohn.1025

PMID

39441616

PMCID

PMC11697529

PubMedCentral® Posted Date

10-23-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Child, Male, Female, Cholesteatoma, Middle Ear, Tympanoplasty, Mastoidectomy, Treatment Outcome, Adolescent, Child, Preschool, Databases, Factual, Retrospective Studies, Reoperation, Hearing Aids

Abstract

OBJECTIVE: The objective of the study is to evaluate the outcomes of surgical management options for cholesteatoma using a national database.

STUDY DESIGN: Database analysis of the Pediatric Health Information System database to identify children undergoing surgical intervention for cholesteatoma from October 2015 to December 2022.

METHODS: Patients were categorized by initial surgical modality: tympanoplasty (TM), tympanoplasty with canal wall-up tympanomastoidectomy (TM-CWU), and tympanoplasty with canal wall-down tympanomastoidectomy (TM-CWD). Group comparisons were done on number of surgical revisions and number of patients identified with recommendations for hearing aids.

RESULTS: A total of 6304 patients were identified in the database who underwent surgery for cholesteatoma. Of these children, 3405 underwent TM (54.0%), 3116 underwent TM-CWU (49.4%), and 825 underwent TM-CWD (8.2%). The estimated difference in mean number of procedures was significantly higher in the TM-CWU group compared to TM-CWD (-0.34, 95% confidence interval [CI] -0.406,-0.279, P < .0001) and the TM group (9.352, 95% CI 0.315, 0.390, P < .0001). The rate of significant hearing loss necessitating hearing aids was significantly lower in the TM group, but there was no difference between the TM-CWU and TM-CWD groups (1.2%, P < .03, 1.9% vs 2.7%, P = .13). There was no difference in the number of speech delays/therapy diagnoses between TM and TM-CWU or TM-CWU and TM-CWD (3.5%vs 4.4% P = .07, 4.4% vs 5.2%., P = .38).

CONCLUSION: TM and TM-CWD had lower total surgical procedures than the TM-CWU group, and the TM group had a lesser rate of recommendation for hearing aids. The difference between number of procedures is likely due to the complexity of the disease; for instance, TM was likely chosen for small, less severe disease cases, whereas TM-CWD was chosen as more definitive treatment in aggressive cases. TM-CWD is associated with a lower rate of recidivism and recurrence, which also likely contributed to the lower number of procedures.