Acquired pediatric cholesteatoma: predictive factors of recurrence. A retrospective study of 11 years]

To define the predictive factors of recurrence of the pediatric acquired cholesteatoma in order to improve the long-term results, to restore a good hearing function and to prevent the complications.A retrospective study concerning all cases of pediatric acquired cholesteatoma, treated during the period 1997-2008 in our center, and followed up for at least one year. A description of the parameters concerning the patients, disease and treatment as well as a univariate analysis were undertaken in order to determine the recurrence predictors. The recurrence-free survival was calculated using the Kaplan-Meier method.26 ears were studied and followed over a mean period of 62 months after the first intervention. The mean age was 12 years (11.7 years) with a 2.7 sex-ratio. The main clinical presentations were otorrhea (65%) and hypoacusia in 42% of cases. Fifteen cases (57.7%) presented an extension to the mastoid, 50% of the ears had an ossicular erosion and 11 cholesteatomas revealed a local or regional invasion. Almost 3/4 (73%) of the cholesteatomas were treated using a canal wall up surgery. The cumulative rate of recurrence was 53.8% and the rate of recurrence-free survival was 84%, 56%, and 44.7% at 12, 24 and 36 months respectively. Only the extension of the cholesteatoma to the mastoid, and the local and regional invasion (sinus tympani, lateral semi-circular canal, facial nerve recess, etc.) of the cholesteatoma at diagnosis, showed a significant higher risk of recurrence (p < 0.05).In our study, the extent of the disease at diagnosis is considered as the major predictive factor of recurrence in pediatric acquired cholesteatoma population raising the problem of delayed diagnosis.