Staged tympanostomy tube placement facilitates pediatric cholesteatoma management

SummaryObjectivesEvaluate results of middle ear ventilation with or without adenoidectomy prior to definitive cholesteatoma surgery in children with concomitant middle ear effusion.MethodsCharts of 40 children seen in follow-up for acquired or congenital cholesteatoma were reviewed. Nine children underwent staged tympanostomy tube placement for concomitant middle ear effusion. Computed tomography was obtained after placement of tubes in all patients. Extent of disease by tomography was compared to disease extent at definitive surgery. Details of cholesteatoma surgeries, most recent disease status, and length of follow-up were recorded.ResultsThree children had extensive congenital cholesteatoma, while six had acquired disease. All nine children underwent tube placement (four with adenoidectomy) prior to definitive surgery. Computed tomography obtained after middle ear ventilation accurately predicted extent of cholesteatoma involvement. Seven atticotomies, two tympanomastoidectomies, and one revision mastoidectomy were performed. Follow-up ranged from 9 to 99 months with a median of 54 months. All were free of cholesteatoma at latest assessment.ConclusionsStaged tympanostomy tube placement with or without adenoidectomy prior to tympanomastoidectomy allows superior delineation of cholesteatoma extent pre-operatively and facilitates surgery in children with concomitant middle ear effusion. Adenoidectomy may improve eustachian tube function and decrease the risk of recurrent disease.