Pediatric Cholesteatoma Follow‐Up: Residual and Recurrence in 239 Cases with Over 5‐Year Hindsight

Abstract

IntroductionPediatric cholesteatoma is an aggressive disease which requires long‐term evaluation to assess management strategies. The objective was to determine optimal follow‐up duration in pediatric cholesteatoma to detect residual and recurrent diseases.MethodsThis cohort study was set in a tertiary referral center. All consecutive patients with a minimum 5‐year follow‐up were included. Medical history, initial extension, surgical procedures, and follow‐up were collected. The main outcome measure were Kaplan–Meier survival curves of residual and recurrence cumulative incidence.ResultsTotally 239 ears with the first tympanoplasty between 2008 and 2014 were studied including 25% congenital. At first surgery (S1), mean age was 8.4 years and mean follow‐up time 7.9 years. Mastoidectomy was performed in 69% and stapes was absent in 38% of cases. Notably, 83% (199 ears) had a second procedure (S2) of which 186 were planned. After S1, maximum cumulated incidence of residual was 45% [95%CI, 38%; 52%] at 74 months, with probability of residual of 39% at 3 years. After S2 (n = 199), maximum cumulated residual incidence was 21% [95%CI, 12%; 32%] at 62 months and 16% at 3 years. Concerning recurrence, maximum cumulated incidence after S1 (n = 239) was reached at 98 months with 21% [95%CI, 12%; 32%], 13% at 3 years and 16% at 5 years. Congenital disease had significantly less residuals after S1 (p = 0.02), but similar recurrence rate (p = 0.66) compared with acquired.Conclusions and RelevanceWe recommend MRI follow‐up of at least 5 years after the last surgery for residual disease and clinical follow‐up of at least 10 years to detect recurrence.Level of Evidence4 Laryngoscope, 2024