Cholesteatoma in children--the experience at The Red Cross War Memorial Children's Hospital in South Africa 1988-1996.

This review of experience with cholesteatoma in children, describes the presentation and features of the disease from a tertiary institution in a 'developing country'. A total of 24 out of 96 cholesteatomas in 81 children (M:F = 44:37) aged 2-12 years initially presented with mastoiditis, with intracranial complications in seven children. Three of the cholesteatomas were congenital, 56 arose from retraction pockets-11 pars flaccida, 45 pars tensa 21 were associated with either a central perforation or total atelectasis and one originated at a ventilation tube site. Open cavity surgery was undertaken in all cases-atticotomy in 14, open mastoid cavity in 82 ears. It was not always possible to preserve reasonably normal pre-operative hearing nor was it possible to improve hearing loss. Twenty-six out of 81 children did not return for follow-up. Even with open cavity surgery, recurrence of cholesteatoma occurred. Late diagnosis, extensive disease, a high rate of complications and poor follow-up are the features of this disease in 'developing' countries.