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        Recurrent cases in pediatric congenital cholesteatoma
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        Recurrent cases in pediatric congenital cholesteatoma
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Learning Objectives:

Congenial cholesteatoma in children is a challenging condition because complete resections sometimes difficult and it often recurs. There are two types of recurrence: residual cholesteatoma and the retraction cholesteatoma. It is very important to know the risk factors of recurrence for the management of congenital cholesteatoma. For this purpose, we compared various factors between the recurrence ( + ) group and (-) group.

Medical records of 67 children under 15 years old who underwent surgery for tympanic type of congenital cholesteatoma from 1999 to 2012 were retrospectively reviewed. Not only cholesteatoma found after onestage surgery but also found during or after second-look operation was defined as recurrence. Because pathophysiology of residual cholesteatoma and retraction cholesteatoma may be different, we investigated risk factors of each type of recurrence separately. Factors compared between the recurrence (+) and (−) groups are age, gender, and stage according to the Potosic classification.

Residual cholesteatoma and retraction cholesteatoma was seen in 14 ears (20.8%) and 4 (6%) ears out of 67 ears, respectively, and 49 patients had no recurrence. There was no significant difference in age and gender between the residual recurrence (+) and recurrence (−) group. However, patients with advanced stage of Potosic classification had more residual recurrence than no recurrence group (p = 0.004). All cases of retraction cholesteatomas were Potosic stage IV, male and age at surgery was 4 ± 0.8, which was significantly younger than recurrence (−) patients (6.4 ± 3.6).

Advanced stage was the significant risk factor for residual cholesteatoma. In contrast, younger patients with advanced stage were the risk factors of retraction recurrence. In surgeries for younger patients with advanced stage, extensive removal of mucosa as well as epithelium have to be performed in young patients with developing tubal function, which might result in retraction recurrence.