Clinical Charateristics of Cholesteatoma in Children

Abstract

Background and Objectives: Cholesteatoma occuring in childhood is usually said to be more aggressive, more frequent recurrence and residual disease than in adults. Cholesteatoma in children is more often associated with larger mastoid air cells, shorter disease history and common secondary infection. Child cholesteatoma often appears behind an intact drum or with a central perforation in clinical feature. The purpose of this study was to investigate the clinical characteristics of cholesteatoma in children by comparing them with those of adult cholesteatoma, and eventually to determine the pathogenesis of childhood cholesteatoma. Materials and Method: The subjects were 62 patients with childhood cholesteatoma who visited Ajou University Hospital between June, 1994 and March, 2000 and the age criteria defining children was less than 16 years. They were carefully analyzed on the basis of OPD charts, temporal bone CTs and operation records, retrospectively. We analysed cholesteatoma classifications, eardrum findings, extents of cholesteatoma, status of ossicular destructions and middle ear status comparing with 157 adult cholesteatoma in the same period. Results: Eardrum findings in childhood cholesteatoma were attic perforation in 37.1%, central perforation in 17.7%, intact in 14.5%, postersuperior perforation in 11.3%, respectively. Attic perforation in childhood cholesteatoma was less than that in adult cholesteatoma (56.7%) but was most common type. Intact drum and central perforation were more than that in adult cholesteatoma. Cholesteatoma in children most frequently extended to the whole middle ear cleft (33.7%), while localization in the attic was most frequently found in adult cholesteatoma (36.9%). The rates of incus and malleus destructions were slightly lower in childhood cholesteatoma, but the rate of stapes suprastructure destruction was slightly higher in children (48.4%) than in adult (43.7%). Involvements of the facial nerve, dura and lateral sinus were less prevalent in children than in adults. Conclusion: The cholesteatoma in children showed some different clinical characteristics from that in adult cholesteatoma suggesting there may be different pathogenesis in children cholesteatoma. And we think this clinical evidences may possibly be a greater source of congenital origin in some childhood cholesteatoma than we had expected.