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Long-term Safety of Tympanomastoid Obliteration for Children with Suppurative Cholesteatomatous Ears

Objectives: Analyze long-term prognosis and safety in children with suppurative cholesteatomatous ears following tympanomastoidectomy with cartilage obliteration. Methods: During a 30-year period (1982-2012), the medical records of children (≤18 years) with cholesteatomas after primary tympanomastoidectomies with cartilage obliteration were analyzed. The recidivism rates were calculated using Kaplan-Meier survival analysis. Potential predictors of recidivism were entered into a Cox’s regression model as covariates for multivariate analysis. These factors were sex, tympanomastoid obliteration, eardrum perforation, ossicular destruction, facial nerve dehiscence, history of ventilation tube insertion, craniofacial abnormality, surgical technique, and extent of disease. Results: Among a total of 150 cholesteatomatous ears in 146 children, there were 95 discharging ears (63%) in 94 children. Among the 95 discharging ears, tympanomastoidectomy was performed with cartilage obliteration (CO group) in 77 ears (81%) and without cartilage obliteration (WO group) in 18 ears (19%). The mean follow-up period was 11.6 ± 8.1 years. Recidivism was observed in 16 years in the CO group (12 recurrent and 4 residual) and 4 in the WO group (2 recurrent and 2 residual). The 10-year cumulative recidivism rates were comparable between CO and WO groups (19% vs. 25%, P = 0.762, log-rank). Multivariate analysis indicated that tympanomastoid obliteration was not a negative predictor of recidivism (P = 0.760), while surgical technique (canal wall up vs. down; hazard ratio = 5.86, P = 0.011) was a significant predictor. Major long-term complications were not observed. Conclusions: This study provides long-term evidence supporting the safety, feasibility, and effectiveness of tympanomastoid cartilage obliteration for children with suppurative cholesteatomatous ears.