Evaluation of second look procedures for pediatric cholesteatomas

Objective. This study aims to identify factors that may help predict recurrence, the need for second-look operations, and other outcomes in the pediatric population. Study Design. Case series with chart review. Setting. Tertiary medical center. Subjects and Methods. Five hundred and seventeen ears in 493 patients underwent primary acquired cholesteatoma resection over a 37-year period. Demographic (age, sex, and other medical conditions), cholesteatoma laterality, presence of perforation or otorrhea on otoscopic exam, preoperative and most recent audiologic data, and detailed intraoperative data were collected. Results. Overall, 47.2% of patients underwent second-look operations, with 48.0% having recurrent cholesteatoma visualized with attic recurrence being the most common location. In total, 22.7% of all patients in this study had recurrent disease. Factors at initial operation associated with a statistically significant increased risk of recurrence included cholesteatoma in the sinus tympani (odds ratio = 2.09; 95% confidence interval, 1.36-3.22) and incus destruction (1.65; 1.01-2.71). Conclusion. The authors have successfully identified multiple factors at the time of initial operation that can have significant postoperative implications.