The surgical treatment of cholesteatoma in children

TLDR: Intact canal wall technique (ICWT) avoids a large cavity in a well pneumatized mastoid and the second stage controls residual cholesteatomas which were more frequent in children (50%) than in adults (22%) and hearing results were better with an intact stapes.

Abstract: Between 1966 and 1981, 141 cholesteatomas were operated upon in children who were 3-15 years old. Radical mastoidectomy was performed in 5 cases. Open cavity tympanoplasty was done in 3 cases. Intact canal wall technique was performed in 99 cases, with a planned second stage in 83 cases (all cholesteatoma cases since 1973). ICWT avoids a large cavity in a well pneumatized mastoid and the second stage controls residual cholesteatomas which were more frequent in children (50%) than in adults (22%). Because of multiple or large residual cholesteatomas, a third stage was performed in 3 cases. Because of a large mesotympanum and/or attic residual cholesteatoma, a transformation of ICWT to an obliteration technique was performed in 4 cases. Retraction pockets were found after the first stage in 12 cases and a transformation of ICWT to an obliteration technique was done in 8 cases at the second stage. Late retraction pockets were found after 5 years in 20% after 2 stages and in 25% after one stage. If a retraction pocket is observed at the second stage, transformation of ICWT to an obliteration technique must be performed. Obliteration technique was performed in 34 cases. A second stage was planned in 26 cases only if the mesotympanum was to be dissected raw. Hearing results were better with an intact stapes (56% of air-bone gap less than or equal to 20 dB).