Iatrogenic cholesteatoma in children with OME in a training program

SummaryPurposeTo report the occurrence of cholesteatoma following myringotomy and insertion of ventilating tube (VT) in a residency training program.Materials and methodsNine hundred and eighty-four children who were operated for grommet insertion with or without adenotonsillectomy during the year 1999–2003 were included in the study. Children were divided into two groups: group 1 (648 children) operated by residents and group 2 (305 children) operated by consultant. All procedures were carried out under general anesthesia using Ziess operating microscope. Shah ventilating tubes were used in most cases and Goody T tube in some others.ResultsNine ears developed cholesteatoma, six with perforation and three with pearl cholesteatoma cyst and intact tympanic membrane. The rate of iatrogenic cholesteatoma occurrence was 0.62% when done by residents (group 1) and 0.33% when operated by consultants (group 2). The overall prevalence was 0.48%.ConclusionIatrogenic cholesteatoma occuring as a complication following VT insertion is not uncommon. It occurs more often following surgery done by inexperienced surgeons. Excessive manipulation may cause meatal wall and drum surface epithelium injury. This epithelium might be pushed with the VT into the middle ear.