Extensive acquired cholesteatoma in children: when the penny drops |
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Authors: | Semple Craig W Mahadevan Murali Berkowitz Robert G |
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Affiliation: | Department of Otolaryngology, Royal Children's Hospital, Melbourne, Australia. |
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Abstract: | OBJECTIVES: To determine the factors associated with the diagnosis of acquired cholesteatoma (AC) in children, we performed a retrospective chart review at a tertiary care center. METHODS: We reviewed children with a diagnosis of AC that extended beyond the mesotympanum in the presence of a nonintact tympanic membrane who underwent surgical treatment over a 14-year period. RESULTS: There were 116 children (78 male, 38 female) between 3 and 18 years of age (mean, 9.5 years). Their average period of management in a specialist otolaryngology clinic before the diagnosis of cholesteatoma was made was 3.2 years, and 68% of the children had previously undergone insertion of tympanostomy tubes. Symptoms and signs included chronic otorrhea (59%), recurrent acute otitis media (58%), and conductive hearing loss (51%). The diagnosis of AC was eventually made after office otoscopy (26%), temporal bone computed tomography (24%), or examination under anesthesia (17%). In 33% of children, the diagnosis was made only after surgical exploration of the middle ear and mastoid. CONCLUSIONS: Our data underscore the importance of maintaining a high index of suspicion for AC in managing children with long-standing otologic symptoms, and considering otomicroscopy, computed tomographic scanning, or tympanomastoid exploration if medical treatment fails. |
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