Surgical Outcome for Congenital Cholesteatoma

Toshinori Kubota, Tsukasa Ito, Takatoshi Furukawa, Hirooki Matsui, Takanari Goto, Kazunori Futai, Chihiro Watanabe, Seiji Kakehata
Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.

Introduction:  We examined the surgical treatment methods for congenital cholesteatomas (CC).

Methods:
Study Design: A prospective case series.
Setting: University hospital.
Patients: Twenty-five patients with CCs who underwent surgery from December 2011 to December 2017 (mean age/range: 7 yr/2–16 yr; 16 male/9 female; mean follow-up/range 3.4 yr/0.6–6.7 yr).
Interventions: Patients underwent either transcanal ear endoscopic surgery (TEES) or non-TEES.

Discussion:
Main Outcome Measures: We examined the surgical approach rate (TEES vs. non-TEES), residual rate and factors related to residual rate (Potsic staging system grade; stages (one-stage or two-stage operations); and CC types (open or closed)). These residual rate factors were analyzed by logistic regression analysis.

Results: Twenty patients (80%) were treated with TEES and 5 patients were treated with non-TEES. The 19 patients with a Potsic grade of III or lower underwent TEES. Six patients (24%) had residual cholesteatomas. The residual rate was significantly influenced by the type of CC (odds ratio: 51.796, 95% confidence interval: 1.7065-1572.1, p=0.0234) with all 6 patients classified as open-type CC and 5 out of the 6 patients underwent a one-stage operation.

Conclusion: The results of this study strongly suggest that the residual rate for CCs could be decreased by performing a two-stage operation for all open-type CCs.