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Richard M. Rosenfeld, MD, MPH; Rejane L. Moura, MD; Charles D. Bluestone, MD

Arch Otolaryngol Head Neck Surg. 1992;118(4):384-391.

Abstract
• The aggressive nature of childhood cholesteatoma has generated much controversy regarding the optimal management of this challenging disorder. To identify potential predictors of residual-recurrent disease, we studied 232 children (244 ears) treated with 427 surgical procedures between 1973 and 1990. Cause of the primary cholesteatoma was congenital in 43 patients (18%), acquired in 83 (36%), and unknown in 106 (46%). Of 90 patients with residual-recurrent disease, 21 (23%) instances were detected during a second-look surgical exploration. The 3- and 5-year residual-recurrence rates were 48% and 57%, respectively. Development of residual-recurrent disease was associated with ossicular erosion (Cox regression) but not with status of the canal wall (up vs down) during tympanomastoidectomy. This study suggests a need for intense and prolonged postoperative follow-up of children with cholesteatoma, especially those with ossicular erosion.

(Arch Otolaryngol Head Neck Surg. 1992;118:384-391)

Author Affiliations
From the Pittsburgh (Pa) Otitis Media Research Center and the Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh (Drs Rosenfeld and Bluestone), and the Department of Otolaryngology, Hospital and Clinics of the Faculty of Medicine, University of São Paulo (Brazil) (Dr Moura). Dr Rosenfeld is now with the Department of Pediatric Otolaryngology, Children's National Medical Center, Washington, DC.

Footnotes
Accepted for publication October 14, 1991.

Read before the annual meeting of the American Society of Pediatric Otolaryngology, Waikoloa, Hawaii, May 9, 1991.

Reprint requests to Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 3705 Fifth Ave, Pittsburgh, PA 15213-2583 (Dr Bluestone).

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