our experience in primary cholesteatoma surgery presentated at the ESPO Paris

1. www.orl-marseille.com
Congenital middle ear
cholesteatomas in children
A Abbas, R Nicollas, I Sudre, H Belaïche, S Roman, JM Triglia
Dr Ali ABBAS
Pediatric ENT department
Timone Children Hospital
Marseille France
20/06/2006

2. Why?
 Problem: early diagnosis
 Comparative study with acquired cholesteatoma in
children
 Objective: to determine criterias allowing earlier diagnosis

3. Material and methods
 Monocentric and comparative prospective study from 1994 to 2005,
 n = 322 cases of cholesteatoma in children
 Mean follow-up = 48 months
 Canal wall up procedure
Congenital cholesteatoma Acquired cholesteatoma
n=61 n=261
4 bilateral cases 14 bilateral cases
Mean age: 6 years [1,1 to 13,9] Mean age: 10 years [3,4 to 18]
Gender: 59% boys gender: 62% boys

4. Results
Clinical n=61
otalgia
non symptomatic
serous otitis media 13%
9% 31%
24%
23%
deafness otorrhea

5. Results
Initial location n=61
anterior superior posterior superior
quadrant quadrant
83 % 31 %
anterior inferior posterior inferior
quadrant quadrant
3% 3%

6. Surgical results
Procedure n=61
 limited pattern (anterior superior): 23% exploratory
tympanotomy (simple removal, better prognosis)
 extended pattern (posterior & diffuse): 77% CWU
tympanomastoidectomy (2nd look reexploration, ossiculoplasty)
Recurrence rate: 20,3% of cases

7. Comparative study (κ 2 Student)
Congenital (n=61) Acquired (n=261)
Asymptomatic 31% 8%
Deafness 24% 24%
Otitis 22% -
Otorrhea 23% 80%
p<0,05

8. Anatomical presentation
Congenital (n = 61) Acquired (n = 261)
“cystic” closed pattern 36% 54%
“infiltrate”opened pattern 64% 46%
without ossicle lysis 63% 25%
incus lysis 64% 68%
stapes lysis 40% 31%
p<0,05

9. Contralateral ear
Congenital (n=61) Acquired (n=261)
Normal 84% 56%
SOM 12% 13%
Chronic otitis 4% 31%
p<0,05

10. Postoperative hearing assessments
Congenital (n=61) Acquired (n=261)
Preoperative ABG (dB): 28 [26 à 59] 27 [7 à 56]
Postoperative ABG (dB): 15 [0 à 47] 17 [0 à 60]
Preoperative mean AC (dB): 38 35
p<0,05

11. Discussion
 Levenson’s criterias:
– CC children with AOM
– under-estimated incidence: perforation post CC
• Location
Series Year Number of Antero-mallear Postero-
cases (%) mallear(%)
Parisier 1989 40 67,5 15
McGill 1991 41 41 0
Postic 2002 172 82 49
Nelson 2002 119 85,1 77
Our study 2006 61 83 31

12. Conclusion
 location relates to postoperative hearing results
and the likelihood of residual disease
 earlier diagnosis = better surgical result
 Large increase in reports of CC