Cholesteatoma: Ossicular destruction in adults and children

The records of 148 adults (aged 14 years and older) presenting previously untreated aural cholesteatomas are analysed with particular emphasis on ossicular destruction and other bony lesions in the middle ear. The findings are compared with those obtained in an earlier study of 63 children (aged 13 years and younger), also with untreated cholesteatomas. The rate of stapes and malleus destruction was similar in adults and children. The rate of incus destruction was significantly higher in adults. Semicircular fistulas as well as facial paralysis were also more prevalent amongst adults. Therefore, the notion of childhood cholesteatoma aggressiveness cannot be related to its effect on these bony structures. It may stem from its higher recurrence rate and from the more troublesome post-operative mastoid cavities, which are often larger in children than in adults.