Learning Objectives:

Introduction: Early congenital cholesteatoma is often undiagnosed and usually presents only when the tympanic membrane is breached and the ear chronically discharges. Early detection and intervention of congenital cholesteatoma should intuitively allow better surgical outcomes. Otitis media with effusion could be an early indicator of underlying cholesteatoma and children presenting with persistent unilateral effusion should be investigated.

Method: Over a 5-year period from 1st March 2009 to 1st March 2014 every child with a persistent unilateral conductive loss, flat tympanometry for 6 months and normal tympanic membrane was listed for insertion of a ventilation tube. At follow up audiological evaluation, any child with persistent hearing loss underwent CT scanning to investigate for cholesteatoma and exploratory mastoid surgery where CT findings were suggestive.

Results: 29 patients in total, age range 3 to 12 years (mean 5 years) were listed for ventilation tube insertion. 2 patients were lost to follow up. 10 patients (34%) had persistent conductive loss at 3 months despite ventilating tubes; 6 patients (21%), age range 4 to 8 years (mean 5 years) had CT scans suggestive of congenital cholesteatoma resulting in mastoid exploration; 5 patients (17%), age range 4 to 8 years (mean 5 years) had congenital cholesteatoma and resulted in mastoidectomy/middle ear surgery.

Conclusion: Persistent unilateral glue ear in a child should be considered suspicious of congenital cholesteatoma. Insertion of a ventilation tube, audiology follow up and CT scan can screen for this otherwise undetected disease, allowing early intervention. The incidence of congenital cholesteatoma in persistent unilateral glue ear in this series is 17%.