Learning Objectives:

Introduction: Acquired cholesteatoma is more aggressive in children than in adults. Despite the aggressive behaviour, radical treatment such as canal wall down technique was less performed to reduce cavity problem which requires endless care. This results in high rate of residues and recurrence. We focused in this study on reducing residues in pediatric acquired cholesteatoma surgery and explored risk factors of residual lesions.

Methods: Medical charts of 39 children under 15 years old with acquired cholesteatoma were retrospectively reviewed. Various factors were compared between the residual cholesteatoma ( + ) and (-) groups: surgical procedures, type of cholesteatoma, number of primary sites of cholesteatoma at surgery (P, protympanum; T, tympanic cavity; A, attic; M, mastoid), development of mastoid air cells, and the status of stapes. Residue ( + ) was defined if residual lesion was found after one-stage surgery or planned two-stage surgery, but not during second-look operation.

Results: Residual cholesteatoma was found ten out of 39 ears (25.6%). Residual sites including overlaps were mastoid cavity (n = 7) followed by tympanic cavity (n = 6) and attic (n = 4), which is different from adult acquired cholesteatoma where the tympanic cavity such as tympanic sinus is the most likely area of residues. Among the various factors examined, significant differences were found between the residue (+) and (−) groups: multiple primary sites such as TAM and PTAM diseases and poor status of stapes were more seen in residue (+) group.

Conclusions: Residual cholesteatoma was mostly seen in mastoid cavity, probably because small piece of epithelium remains in honeycomb structure of well-developing mastoid cavity, which is a characteristic feature of mastoid in children. In order to minimize the residual lesion, surgeons should take care of complete removal of mastoid cholesteatoma especially in patients with advanced case such as multiple primary sites and with invasion to stapes.