Learning Objectives: bony obliteration technique in pediatric aquired cholesteatoma - results and discussionon advantageges

Paediatric cholesteatoma is aggressive, destructive disease to all surrounding tissues. It has high recurrent tendency even after careful removal. High complication rate, severe, sometimes life-threatening complications can occur. Hearing deterioration is characteristic. Main goals of therapy are the following:

• • complete eradication of the disease (no residual disease)

• • prevention of recurrent disease, prevention complications

• • improvement of the hygienic status of the ear

• • preservation or improvement of hearing

Formerly in childhood mostly operations has been done in 2 sessions: one year after the first op – enough time to grow a „spider-egg” to be removed and reconstruction. Today the method of choice is in cases of invagination cholesteatoma the CWU /CWD with BOT, complete removal the matrix and keratin, primary reconstruction of the ear. For control of recurrent/ residual cholesteatoma is done by non-epi DW MRI.

Own results: In the last 5 years we had 53 cholest cases, 4 congenital, 49 epitympanic, and invagination type. In non-obliteration cases (n = 32) the recurrent/residual rate was 37, 5% (12), in obliteration cases (n = 17) this figure was 5, 9% (1). Hearing results in obliteration group was better than in non-obliteration group (average ABG improvement was 5, 3 vs 12, 5 dB).

Conclusion: After a learning curve BOT surgery is the method of choice in paediatric invagination cholesteatoma cases.