Multidimensional staging system for pediatric acquired cholesteatoma: A 30-year verification data

Abstract Objective This article presents a points-based prognostic prediction model for pediatric acquired cholesteatoma, incorporating the multidimensional factors that contribute to surgical failure. Methods This study included 132 ears with acquired cholesteatoma from 128 children (≤18 years) ide...

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Bibliographic Details
Published in:Auris, nasus, larynx nasus, larynx, 2016-08, Vol.43 (4), p.387-394
Main Authors: Kuo, Chin-Lung, Shiao, An-Suey, Chen, Chien-Hao, Lien, Chiang-Feng
Format: Article
Language:English
Subjects:
Adolescent
Age Factors
Child
Child, Preschool
Children
Cholesteatoma
Cholesteatoma, Middle Ear - surgery
Classification
Ear Ossicles
Female
Follow-Up Studies
Humans
Male
Mastoid - surgery
Middle Ear Ventilation
Otolaryngology
Prognosis
Recurrence
Retrospective Studies
Severity of Illness Index
Staging
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Summary:Abstract Objective This article presents a points-based prognostic prediction model for pediatric acquired cholesteatoma, incorporating the multidimensional factors that contribute to surgical failure. Methods This study included 132 ears with acquired cholesteatoma from 128 children (≤18 years) identified between 1982 and 2012. Each case was scored for the extent of the cholesteatoma, history of grommet insertion, age of the patient, ossicular destruction, and otorrhea. The patients were classified as stage I, II, or III. We compared differences between stages regarding the cumulative rates of recidivism and linear trends in these rates. Results Among stage I cases, the rate of cumulative recidivism was 0%; however, among stage 2 cases, this increased with time, eventually leveling off at 15.7% after 18 years of follow-up. The same was observed among stage III cases, which leveled off at 34.1% after 17 years of follow-up. In the second half of the cohort and the entire cohort, differences in the cumulative recidivism curves reached statistical significance, as did the linear trends (all p < 0.05). Conclusions Our findings demonstrate the efficacy of the proposed multidimensional staging system in linking the severity of cholesteatoma to outcomes, thereby enabling the stratification of patients according to prognosis in order to identify children at risk of recidivism.
ISSN:0385-8146
1879-1476
DOI:10.1016/j.anl.2015.09.007