[Acquired pediatric cholesteatoma: predictive factors of recurrence. A retrospective study of 11 years].

AIM OF THE STUDY

To define the predictive factors of recurrence of the pediatric acquired cholesteatoma in order to improve the long-term results, to restore a good hearing function and to prevent the complications.

PATIENTS AND METHODS

A retrospective study concerning all cases of pediatric acquired cholesteatoma, treated during the period 1997-2008 in our center, and followed up for at least one year. A description of the parameters concerning the patients, disease and treatment as well as a univariate analysis were undertaken in order to determine the recurrence predictors. The recurrence-free survival was calculated using the Kaplan-Meier method.

RESULTS

26 ears were studied and followed over a mean period of 62 months after the first intervention. The mean age was 12 years (11.7 years) with a 2.7 sex-ratio. The main clinical presentations were otorrhea (65%) and hypoacusia in 42% of cases. Fifteen cases (57.7%) presented an extension to the mastoid, 50% of the ears had an ossicular erosion and 11 cholesteatomas revealed a local or regional invasion. Almost 3/4 (73%) of the cholesteatomas were treated using a canal wall up surgery. The cumulative rate of recurrence was 53.8% and the rate of recurrence-free survival was 84%, 56%, and 44.7% at 12, 24 and 36 months respectively. Only the extension of the cholesteatoma to the mastoid, and the local and regional invasion (sinus tympani, lateral semi-circular canal, facial nerve recess, etc.) of the cholesteatoma at diagnosis, showed a significant higher risk of recurrence (p < 0.05).

CONCLUSION

In our study, the extent of the disease at diagnosis is considered as the major predictive factor of recurrence in pediatric acquired cholesteatoma population raising the problem of delayed diagnosis.