Impact of cleft palate type on the incidence of acquired cholesteatoma

Objectives The objectives of this study were to determine the incidence of acquired cholesteatoma in children with congenital cleft palate, and to determine the impact of various cleft palate types (cleft lip and palate, cleft palate alone, submucous cleft palate) on the development of acquired cholesteatoma.Materials and methods This is a retrospective cohort study spanning a 25-year period from 1981 to 2005. The Cleft Palate Registry at the Hospital for Sick Children in Toronto, Canada was cross-referenced with the hospital's surgical pathology database to identify all children with cleft palate and acquired cholesteatoma. Accuracy and completeness of the datasets were confirmed by comparison with hospital records and other databases.Results There were 2737 children who underwent palatoplasty over the study period, and 44 of these children developed an acquired cholesteatoma. Adjusting for censored data by Kaplan Meier analysis, the incidence of cholesteatoma was 2.2% between the ages 5 and 18 years, or 0.2% per year. Acquired cholesteatoma was 3 times more common in cleft lip and palate than cleft palate alone (p = 0.002, Kaplan Meier Log-rank survival analysis).Conclusions The rate of acquired cholesteatoma in children with cleft palate is approximately 200 times the baseline rate. Children, especially teenagers, with cleft lip and palate appear to be at significantly higher risk for acquired cholesteatoma than children with cleft palate alone.