Surgical Strategy for Pediatric Cholesteatoma

Background: Eradication of cholesteatoma and hearing function restoration in paediatric patients present unique surgical challenges. The balance between these two goals is related to an individualized approach which is needed for the treatment of pediatric cholesteatoma. Objective: To evaluate management strategy for pediatric cholesteatoma, by performing Canal Wall Up (CWU) and Canal Wall Down (CWD) technique if needed as regarding complete eradication of the disease, restoration of normal ear function and recurrence or residual disease. Patients and Methods: This is a prospective study carried out over a period of three years from October 2011 and September 2014 at Mansoura University Otolaryngology Department. Forty cases with cholesteatoma irrespective of the presence or absence of complications were selected for the study. Otoscopic, otomicroscopic and tuning fork tests, when possible, were performed. Auditory Brain Response (ABR) or Pure Tone Audiometry (PTA) was done for all cases. Audiometric results were analysed according to the International Bureau for Audiophonology (BIAP) criteria. High Resolution Computerized Tomography (HRCT) temporal bone was done for all cases. Informed consent was obtained from all patients after counseling the parents. All of the cases underwent tympanomastoidectomy by a postauricular approach. Using suitable surgical technique (Atticotomy, modified CWU technique or CWD). Reconstruction of hearing mechanism was performed in all possible cases. Results: There was significant difference in healing duration between both CWU and CWD. There was a strong correlation between HRCT and intra operative findings regarding ossicular status. There was significant difference in the mean postoperative AB gap in CWD but there was no significant difference in CWU and Atticotomy. Cholesteatoma recidivism in CWU (12.5%), and no cases of residual or recurrence in CWD and Atticotomy. Conclusion: The type of mastoidectomy doesn't affect hearing outcome. The patient is better served by a single operation which selected and meticulously accomplished. Our management strategy for pediatric cholesteatoma is aiming at performing a single stage surgery with the help of preoperative HRCT and intraoperative otoendoscopes using suitable surgical technique (Atticotomy, modified CWU technique or CWD). Correspondence to: Dr. Ahmed S. El-Deeb, The Department of Otolaryngology, Faculty of Medicine, Mansoura University