Pre-School Pediatric Cholesteatoma: 46 Cases

Pediatric cholesteatoma is classified into congenital cholesteatoma and acquired cholesteatoma. As congenital cholesteatoma has few symptoms, the cases are usually discovered with hearing loss during the examination during enrollment in an elementary school. Acquired cholesteatoma is associated with inflammatory changes and eustachian tube dysfunction of the middle ear, and it is said that most cases are more severe than congenital cholesteatoma. We analyzed 46 cases (47 ears) of pediatric cholesteatoma, diagnosed before attending school and operated upon. We also examined the discovery mechanism, classification, progress level, operative methods of cholesteatoma, postoperative hearing tests, and recurrences. Approximately 85% of these cases were of congenital cholesteatoma; additionally, approximately 15% had acquired cholesteatoma. As a result, there were no significant differences between congenital cholesteatoma cases and acquired cholesteatoma cases in terms of the degree of progression, hearing ability prognosis, and rate of recurrence. Moreover, the rate of recurrence and hearing ability prognoses were better than those in previous reports. In general, there are several cases in which the cholesteatoma extends to anatomical blind spots such as the tympanic sinus or facial recess in pediatric cholesteatoma. Several papers have discussed the availability of middle ear surgeries using endoscopy (i.e., trans canal endoscopic ear surgery [TEES]). However, we performed middle ear surgery using microscopy (i.e., microscopic ear surgery [MES]) in all cases, and we have invented a way to find operation fields using procedures such as drilling the anterior wall of the external auditory canals. In conclusion, we believe that polite dissection of the cholesteatoma matrix under the microscope is an important factor in the low rate of recurrence of cholesteatoma..