Cholesteatoma in the pediatric population: prognostic indicators for surgical decision making.

A review of surgical therapy for pediatric cholesteatoma at the Arkansas Children's Hospital was performed. Fifty-three children treated surgically for cholesteatoma were studied over a 10-year period. Primary acquired, or attic retraction cholesteatomas, were generally treated with a canal up tympanomastoidectomy; there were very few complications or secondary procedures in this group. Middle ear or secondary acquired cholesteatomas were initially treated by both canal up and canal down procedures; however, a large percentage of these patients eventually required an open cavity procedure. The presence of cholesteatoma in the sinus tympani strongly predicted failure to control disease with a canal up procedure (P < .05); conversely, the absence of matrix in the sinus tympani was predictive for success when a canal up procedure was used for attic cholesteatoma (P < .05). Finally, it was determined that follow-up was not adequate in our patient population. With this in mind, guidelines for the management of pediatric cholesteatoma will be presented.