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Pediatric Otolaryngology

Outcomes in Pediatric Cholesteatoma: A National Database Study

Monday, October 2, 2023
8:36 AM - 8:42 AM East Coast USA Time
Location: 207CD

    Presenting Author(s)

  • KM

    Katherine M. Miller, MD,

    Resident Physician
    Cleveland Clinic Foundation
    Cleveland, OH, United States

    • Co-Author(s)

  • YL

    Yi-Chun Carol Liu, MD

    Associate Professor
    Texas Children's Hospital/Baylor College of Medicine
    Houston, TX, United States

  • Jaqueline E. Weinstein, MD

    Associate Professor
    University of California San Francisco
    San Francisco, CA, United States

  • David H. Chi, MD

    Division Chief
    University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh
    Pittsburgh, PA, United States

    • Presenting Author(s)

  • MC

    Michael S. Cohen, MD

    Assistant Professor
    Harvard/MEEI
    Boston, MA, United States

    • Co-Author(s)

  • SA

    Samantha Anne, MD, MS

    Medical Director, Pediatric Ear and Hearing Disorders; Associate Professor, Pediatric Otolaryngology
    Cleveland Clinic
    Cleveland, Ohio, United States

    • Senior Author(s)

  • SA

    Samantha Anne, MD, MS

    Medical Director, Pediatric Ear and Hearing Disorders; Associate Professor, Pediatric Otolaryngology
    Cleveland Clinic
    Cleveland, Ohio, United States

Disclosure(s):
Katherine M. Miller, MD,: No relevant relationships to disclose.
Samantha Anne, MD, MS: No relevant relationships to disclose.
Introduction: Surgery for pediatric cholesteatoma includes tympanoplasty for limited disease or may include mastoidectomy for more extensive disease. Objective of the study is to evaluate outcomes of surgical management options for cholesteatoma

Methods: The Pediatric Health Information System (PHIS) database was used to identify children that had surgery for cholesteatoma from 10/2015-12/2022. Patients were categorized into 3 groups by initial surgical modality: tympanoplasty (TM), tympanoplasty with canal wall-up mastoidectomy(TM-CWU), and tympanoplasty with canal wall-down mastoidectomy (TM-CWD). Group comparisons were done on number of surgical procedures (revisions) and the number of patients identified with diagnoses for hearing aids and speech delay/therapies.

Results: There were 6425 patients in the database who underwent surgery for cholesteatoma. Of these children, 2751 underwent tympanoplasty (42.8%), 2932 underwent TM-CWU (45.6%), and 697 underwent TM-CWD (10.8%). Average number of procedures was 1.27, 1.61, and 1.42 in those who initially underwent TM, TM-CWU, and TM-CWD, respectively. The rate of diagnoses for hearing aid was significantly lower in the TM group, but there was no difference between the TM-CWU and TM-CWD groups (1.2%, p< 0.03, 1.9% vs. 2.7%, p=0.13). There was no difference in number of speech delays or therapy diagnoses between tympanoplasty and TM-CWU or TM-CWU and TM-CWD(3.5%vs 4.4% p=0.07, 4.4%vs. 5.2%., p=0.38), though they occurred less frequently in the TM group versus TM-CWD cohort (3.5% vs. 5.2%, p=0.04).

Conclusions: Tympanoplasty was associated with lower rates of complications at initial presentation suggestive of lesser severity of disease, lower number of surgeries overall, and lesser rate of diagnoses of hearing aids. There is a higher need for revision procedures among those initially managed with TM-CWU, but no differences in rate of diagnoses of hearing aids or speech delays/therapies in comparison to TM-CWD procedures. Future studies are needed to understand quality of life outcomes, costs, and other factors impacting shared decision-making in these patients.