Cholesteatoma in children: recurrence related to observation period.

From 1965 to 1978, 122 children with cholesteatoma had one-stage surgery. Follow-up examinations were carried out several times, with the last two taking place in 1980/81 and 1985/86. Ninety-eight percent of the children were seen at follow-up; the median observation time was 11 years, with a range of three to 21 years. The increase in recurrence rate with increasing observation time was analyzed. In 1980/81 there was a total recurrence rate of 12 percent of patients, including residual cholesteatoma in the tympanic cavity in 8%, in the attic in 2%, and recurrent cholesteatoma in 2%. In 1985/86 the recurrence rate had increased to 17%, distributed among residual cholesteatoma in the tympanic cavity in 10.6%, in the attic in 1.6%, and recurrent cholesteatoma in 4.8%. The recurrence rate was the same regardless of whether modified canal-wall-up mastoidectomy or canal-wall-down mastoidectomy had been employed. We conclude that cholesteatoma surgery should be individualized according to pathologic findings in the tympanic cavity, tubal function, and size of the mastoid air cell system. Small cholesteatomas confined to the tympanic cavity may be removed by tympanoplasty alone, without mastoidectomy. In ears with adhesive otitis, canal-wall-down mastoidectomy is preferred; and in ears with a reasonably good tubal function and a large air cell system, canal-wall-up mastoidectomy is recommended. The long-term results reported here seem to indicate that, in children, canal-wall-up mastoidectomy is preferable to canal-wall-down mastoidectomy.