Pediatric Cholesteatoma: Congenital versus Acquired

Objective1) To compare the characteristics of congenital and acquired pediatric cholesteatoma. 2) To investigate the risk factors influencing recidivism after initial surgery to propose a guided therapeutic approach.MethodRetrospective analysis was made on pediatric cholesteatoma cases under the age of 18 years. A total of 163 patients (92 of congenital and 71 of acquired cholesteatoma) were operated by the same surgeon from 1993 to 2011. We analyzed the symptoms, physical findings, computed tomography, operative findings, hearing, and recurrence.ResultsThe ages at diagnosis and operation in congenital cholesteatoma were significantly younger than acquired. The chief complaint of congenital was mainly the incidental mass (74%), whereas the otorrhea (66%) in acquired. Mass shadow behind the intact tympanic membrane was observed in 95% of congenital cholesteatoma. The main tympanic membrane abnormalities of acquired cholesteatoma were attic retraction and pars tensa perforation (56% and 56%). Invasion of epitympanum and ossicular erosion were more frequently found in the acquired cholesteatoma (P <. 05). There was no difference in recurrence rate between congenital and acquired cholesteatoma. Statistically significant factors at high risk of recurrence were pars tensa perforation, diploic pneumatization, incus erosion. On the other hand, lowering risk factors were sclerotic mastoid on CT and no mastoidectomy.ConclusionThe congenital and acquired cholesteatoma showed very different clinical features. Careful eradication and continued follow‐up is recommended in the children with high risk of recurrence.