Paediatric acquired cholesteatoma, our experience in a tertiary care: two year prospective study


  • Akshay Jain Department of ENT, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh
  • Smruti Milan Tripathi Department of ENT, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh
  • Poonji Gupta Department of ENT, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh



Cholesteatoma, Paediatric, Temporal bone, HRCT


Background: Aim of the study was to estimate the benefits of having high-resolution computed tomography (HRCT) of temporal bone on clinically evaluated paediatric patients of acquired cholesteatoma.

Methods: A total of 60 patients of paediatric age group (2-18 years) who were diagnosed with active squamosal type of chronic otitis media were selected for the study. HRCT of temporal bone was done in all the patients and findings were recorded.

Results: Most patients were in the age group of 11-15 years (46.6%). Findings of pars tensa were subtotal perforation in 2 patients (3.3%), small central perforation in 8 patients (13.3%) and postero-superior marginal perforation in 12 patients (20%). Pars flaccida retraction pocket with cholesteatoma was seen in 31 patients (51.6%) and perforation with cholesteatoma in 13 patients (21.6%). Scutum erosion was seen in 31 patients (51.6%), ossicular erosion in 12 patients (20%) and facial nerve paralysis in 2 patients (3.3%). On HRCT temporal bone we found soft tissue density in middle ear in 60 patients (100%), soft tissue density in mastoid in 53patients (88.3%), osscicular erosion in 54 patients (90%), scutum erosion in 46 patients (76.6%), facial nerve canal dehiscence in 5 patients (8.3%), semicircular canal dehiscence in 2 patients (3.3%) and dural plate dehiscence in 11 patients (18.3%).

Conclusions: HRCT of temporal bone is helpful in depicting a clearer picture of middle ear cavity structures involved by cholesteatoma and thus helpful in formulating a strategy for further management.

Author Biographies

Akshay Jain, Department of ENT, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh

Assistant Professor

ENT Department

Smruti Milan Tripathi, Department of ENT, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh

Associate Professor

ENT Department

Poonji Gupta, Department of ENT, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh

Assistant Professor

ENT Department


Hamed MA, Nakata S, Sayed RH. Pathogenesis and bone resorption in acquired cholesteatoma: current knowledge and future prospectives. Clin Experimental Otorhinolaryngol. 2016;9(4):298-308.

Kurihara A, Toshima M, Yuasa R, Takasaka T. Bone destruction mechanisms in chronic otitis media with cholesteatoma: specific production by cholesteatoma tissue in culture of bone-resorbing activity attributable to interleukin-1 alpha. Ann Otol Rhinol Laryn¬gol. 1991;100(12):989-98.

Jung JY, Chole RA. Bone resorption in chronic otitis media: therole of the osteoclast. ORL J Otorhinolaryngol Relat Spec. 2002;64(2):95-107.

Schraff SA, Strasnick B. Pediatric cholesteatoma: a retrospective review. Int J Pediatr Otorhinolaryngol. 2006;70:385-93.

Morita Y, Yamamoto Y, Oshima S, Takahashi K, TakahashiS. Acquired cholesteatoma in children: clinical features andsurgical outcome. Auris Nasus Larynx. 2014;41:417-21.

Glasscock ME, Dickins JR, Wiet R. Cholesteatoma in children. Laryngoscope. 1981;91(10):1743-53.

Ruah CB, Schachern PA, Paparella MM, Zelterman D. Mechanisms of retraction pocket formation in the pediatric tympanic membrane. Arch Otolaryngol Head Neck Surg. 1992;118(12):1298-305.

Bujia J, Holly A, Candela FA, Tapia MG, Kastenbauer E. Immunobiological peculiarities of cholesteatoma in children: quantification of epithelial proliferation by MIB1. Laryngoscope. 1996;106(7):865-8.

Palva A, Karma P, Karja J. Cholesteatoma in children. Arch Otolaryngol. 1977;103(2):74-7.

Sudhoff H, Tos M. Pathogenesis of attic cholesteatoma: clinical and immunohistochemical support for combination of retraction theory and proliferation theory. Am J Otol. 2000;21(6):786-92.

Quaranta A, Resta L, Santangelo A. Otomastoid cholesteatoma in children: histopathological findings. Int J Pediatr Otorhino-laryngol. 1986;12(2):121-6.

Dornelles C, Sady SC, Meurer L, Rosito LP, Andrei R, Alves SL. Comparison of acquired cholesteatoma between pediatric and adult patients. Eur Arch Otorhinolaryn- gol. 2009;266(10):1553-61.

Alves AL, Pereria CS, Rebeiro FA, Fregnani JHT. Analysis of histopathological aspects in acquired middle ear cholesteatoma. Braz J Otorhinolaryngol. 2008;74(6):835-41.

Aslier M, Erdag TK, Sarioglu S, Guneri EA, Ikiz AO, Uzun E, et al. Analysis of histopathological aspects and bone destruction characteristics in acquired middle ear cholesteatoma of pediatric and adult patients. Int J Pediatr Otorhinolaryngol. 2016;82:73-7.

Olszewska E, Wagner M, Bernal-Sprekelsen M, Ebmeyer J, Dazert S, Hildmann H, Sudhoff H. Etiopathogenesis of cholesteatoma. Eur Arch Otorhinolaryngol. 2004;261(1):6-24.

Magliulo G, Colicchio MG, Appiani MC. Facial nerve dehiscence and cholesteatoma. Ann Otol Rhinol Laryngol. 2011;120(4):261-7.

Moody MW, Lambert PR. Incidence of dehiscence of the facial nerve in 416 cases of cholesteatoma. Otol Neurotol. 2007;28(3):400-4.

Ng JH, Zhang EZ, Soon SR, Tan VYJ, Tan TY, Mok PKH, et al. Pre-operative high resolution computed tomography scans for cholesteatoma: has anything changed?. Am J Otolaryngol. 2014;35(4): 508-13.

Manolis EN, Filippou D, Tsoumakas K, Diomidous M, Cunningham MJ, Katostaras T, et al. Radiologic evaluation of the ear anatomy in pediatric cholesteatoma. J Craniofac Surg. 2009;20(3):807-10.

Kim SY, Kim HS, Park MH, Lee JH, Oh SH, Chang SO, Kim CS, Jung AY, Kim YH. Optimal use of CT imaging in pediatric congenital cholesteatoma. Auris Nasus Larynx. 2017;44(3):266-71.

Palva T, Karma P, and Makinen J. The invasion theory. In: Sade J, eds. Cholesteatoma and mastoid surgery. Amsterdam: Kugler Publications; 1982.

Smyth GDL. Treatment of cholesteatoma. ActaOtorhinolaryngologica Belgica. 1973;25:970-8.

Glasscock ME, Dickins JRE, Welt R. Cholesteatoma inchildren. The Laryngoscope. 1981;91:1743-53.

Wullstein SR. Cholesteatoma in children: is the diseasedifferent in children?. Clin Otolaryngol. 1978;3:353-62.

Abramson M, Lachenbreech PA, Press BHJ, McCabe BF. Results of conservative surgery for middle ear choalesteatoma. Laryngoscope. 1977;87: 1281-6.

Edelstein PR, Parisier SC, Ahuja GS, Charles J, Chute P, Shutowenig, SMK. Cholesteatoma in the pediatric age group Ann Otol Rhinol Laryngol. 1988;97:23-9.

Diom ES, Cisse Z, Tall A, Ndiaye M, Pegbessou E, Ndiaye IC, et al. Management of acquired cholesteatoma in children: A 15 year review in ENT service of CHNU de FANN Dakar. Int J Pediatr Otorhinolaryngol. 2013;77(12):1998-2003.

Gupta V, Mirza N, Gupta A. Clinical aspects and surgical outcomes of pediatric cholesteatoma in atertiary care teaching hospital. Int J Otorhinolaryngol Head Neck Surg. 2019;5(2):340-4.

Triglia JH, Gillot JC, Giovanni A, Cannom M. Cholesteatoma of the middle ear in children. Ann Otolaryngol Chirurgie Cervicofacial. 1993;110(8) :437-43.

Khavasi P, Karra B, Malashetti SP. Acquired cholesteatoma in children: presentation, complications and management. Int J Otorhinolaryngol Head Neck Surg. 2018;4(4):1017-22.

Gamra OB, Abid W, Nacef I, Romdhane N, Hariga I, Mbarek C, et al. Acquired cholesteatoma in children: Clinical features and surgical results. Egyptian Journal of Ear, Nose, Throat Allied Sci. 2016;17:1-6.

Zorita C, Villar J, Bosch J. Long-term results of cholesteatoma surgery in children. Acta Otorrinolaringologica Espanola. 1994;45(4):233-6.

Sadé J, Shatz A. Cholesteatoma in children. J Laryngol Otol. 1988;102(11):1003-6.

Jackler RK, Dillon WP, Schindler RA. Computed tomography in suppurative ear disease: a correlation of surgical and radiographic findings. Laryngoscope. 1984;94(6):746-52.

Gaurano JL, Joharjy IA. Middle ear cholesteatoma: characteristic CT findings in 64 patients. Ann Saudi Med. 2004;24(6):442-7.

O'Reilly BJ, Chevretton EB, Wylie I, Thakkar C, Butler P, Sathanathan N, Morrison GA, Kenyon GS. The value of CT scanning in chronic suppurative otitis media. J Laryngol Otol. 1991;105(12):990-4.






Original Research Articles