Preference for the closed technique in the management of cholesteatoma of the middle ear in children: a retrospective study of 215 consecutive patients treated over 10 years.

Objectives: To evaluate clinical data, extensions, residual and recurrent lesion rates, and functional results in cases of cholesteatoma in pediatric patients.

Design: A retrospective study at a single tertiary care center over a decade.

Patients: In 199 children (mean age 9.6 years), 215 cholesteatomas were treated surgically, and the children were followed up for an average of 70 months (range 25-118 months).

Interventions: Therapeutic and rehabilitative surgical procedures were done, using either a closed technique (CT) or an open technique: tympanoplasty in open technique (TOT), radical mastoidectomy (RM), or Rambo's technique)

Main outcome measures: Surgical findings, residual and recurrent lesions rate, and hearing assessment.

Results: The first surgical procedure was CT in 88% of cases, TOT in 10%, RM and Rambo's technique in 1%. Two operations were done in 61.8% of children; 21% had three operations and 4.5% had four. Residual lesions were observed in 21.5% of all children, 32.8% in those undergoing a planned second look. Recurrence rate was 9.8%. Surprisingly, residual and recurrent lesion rates were higher after TOT (23.8% and 19%) than after CT (20.5%, 8.9%), but TOT-treated children had much more extensive lesions. A speech reception threshold (SRT) <30 dB hearing loss (HL) was achieved in 63.7% of patients, and normal hearing was obtained in 12.1%; SRT was significantly better after CT (mean 26.7 dB) than after TOT (mean 37.4 dB), after type II (mean 27 dB) than after type III (35 dB). A high-frequency pure-tone hearing loss >10 dB was uncommon (7.6%).

Conclusion: These results support the continued use of CT in most cases of cholesteatoma in children in developed countries.