# Bilateral middle ear cholesteatoma in children: A single-center retrospective study

## TL;DR

This study examines the treatment and outcomes of children with bilateral middle ear cholesteatoma, highlighting the importance of staged surgery and long-term follow-up due to high recurrence rates.

## Contribution

The study proposes a management flowchart for bilateral middle ear cholesteatoma in children based on clinical experience and outcomes.

## Key findings

- Staged bilateral surgery is preferred, with surgery on the worse side first.
- Postoperative hearing showed no significant difference between congenital and acquired cholesteatoma.
- Bilateral middle ear cholesteatoma has a high recurrence rate requiring long-term follow-up.

## Abstract

•The incidence of cleft palate malformation in BMEC is high.•Staging bilateral surgery is preferred and surgery on the worse side first.•Simultaneous bilateral surgery in children should be carefully considered.•Postoperative hearing showed no significant difference between CC and AC in BMEC.•BMEC has a high recurrence rate after operation and require a long-term follow-up.

The incidence of cleft palate malformation in BMEC is high.

Staging bilateral surgery is preferred and surgery on the worse side first.

Simultaneous bilateral surgery in children should be carefully considered.

Postoperative hearing showed no significant difference between CC and AC in BMEC.

BMEC has a high recurrence rate after operation and require a long-term follow-up.

To analyze the clinical characteristics of bilateral cholesteatoma in children and summarize the clinical treatment pathway.

In this retrospective cohort study, we analyzed the records of children with bilateral middle ear cholesteatoma who underwent surgery in our department between 2016 and 2023. The clinical characteristics, treatment and prognosis were analyzed.

The records of 12-children (24-ears, 4girls and 8-boys) were reviewed. The mean age was 6.5 ± 2.6-years. Four children had Congenital Cholesteatoma (CC) in one ear and Acquired Cholesteatoma (AC) in the other ear and 8-children had AC in both ears. The onset time and lesion degree of the bilateral ears are different. Nine children had maxillary developmental deformities (75%). One child underwent simultaneous binaural surgery, and 11 underwent staged surgery, with a median interval of 3-months between surgeries. The follow-up period was 4.28 ± 2.58-years. No postoperative complications. Six children (7-ears) underwent revision surgery due to recurrence. There was no significant difference in hearing results between pure-tone average of preoperative (41.23 ± 16.50 dB) and postoperative (37.79 ± 14.42 dB) (p = 0.291, t = 1.082). There was no significant difference in postoperative hearing between CC and AC (p = 0.355, F = 4.268). There were significant differences in postoperation hearing among different surgical methods (p = 0.006, H = 12.630). There were significant differences in postoperation hearing among different ossiculoplasty methods (p = 0.001, H = 17.590).

In our cohort, the average age at diagnosis of bilateral cholesteatoma in children was notably young, with a high proportion presenting concurrent cleft palate deformities. Staged surgical intervention prioritizing the more severely affected ear was adopted for bilateral cases. Furthermore, long-term follow-up is necessary due to the observed high recurrence rate in this population. A management flowchart has been proposed based on our therapeutic experience.

Level 4.