The results of 32 ears that underwent tympanoplasty for cholesteatoma in children under 9 years old were compared with those of 22 ears of adolescent (10 to 15 years) and 63 ears of adult (over 16 years). The planned staged tympanoplasty was performed in 68.8% of children, 45.5% of adolescents, but only 19.0% of adults. The canal wall up procedure was employed in 71.9% of children and in 87.1% of patients over 10 years.
At the second operation of planned staged tympanoplasty or the planned second look operation, a pearl-like residual cholesteatoma was found in 16% of children, and in 21.1% of patients over 10 years. But these planned revised operations were underwent in 78.1% of children, whereas only in 22.4% of patients over 10 years. The need for revised operation is greater in children than in adolescents and adults.
Residual cholesteatoma was found in 15.2% treated by the canal wall up procedure and in 27.3% by the canal wall down procedure in all revised ears. Higher incidence of residual cholesteatoma in the canal wall down procedure than in the canal wall up procedure was thought to be caused that the former was performed in extensive and aggresive cholesteatoma.
The incidence of recurrent cholesteatoma after the canal wall up procedure was the same in children (4.3%) and patients over 10 years (5.4%). Recurrence is closely related to dysfunction of the eustachian tube or tympano-mastoid aeration. We found that in ears with poor eustachian tube function, complete tympano-mastoid blockage by cortical bone fragments was the most effective preventative technique against recurrent cholesteatoma, though reconstruction of scutum and repair of tympano-mastoid aeration were useful for ears with good eustachian tube function.
