Pediatric Ears

Factors associated with developing cholesteatoma: A study of 45,980 children with middle ear disease†

  1. Katrina Spilsbury PhD1,*,
  2. Ian Miller MRCSI3,
  3. James B. Semmens PhD1,
  4. Francis J. Lannigan MD, FRACS2,3

Article first published online: 7 JAN 2010

DOI: 10.1002/lary.20765

Issue

The Laryngoscope

The Laryngoscope

Volume 120, Issue 3, pages 625–630, March 2010

Additional Information

How to Cite

Spilsbury, K., Miller, I., Semmens, J. B. and Lannigan, F. J. (2010), Factors associated with developing cholesteatoma: A study of 45,980 children with middle ear disease. The Laryngoscope, 120: 625–630. doi: 10.1002/lary.20765

Author Information

  1. 1

    Centre for Population Health Research, Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Australia

  2. 2

    Department of Paediatric Otolaryngology, Princess Margaret Hospital, Subiaco, Australia

  3. 3

    and the School of Medicine, Notre Dame University, Fremantle, Australia

*Centre for Population Health Research, Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, Perth Western Australia 6845, Australia

  1. †

    This project was funded through the Western Australian Safety and Quality of Surgical Care Project by an Australian National Health and Medical Research Council project grant.

Publication History

  1. Issue published online: 16 FEB 2010
  2. Article first published online: 7 JAN 2010
  3. Manuscript Accepted: 30 SEP 2010
  4. Manuscript Revised: 23 SEP 2010
  5. Manuscript Received: 25 AUG 2010

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Keywords:

  • Ventilation tubes;
  • cholesteatoma;
  • survival analysis;
  • medical record linkage

Abstract

Objectives/Hypothesis:

To identify factors associated with the rate of developing cholesteatoma following ventilation tube insertion (VTI).

Study Design:

A population-based retrospective cohort study.

Methods:

Administrative health data from all private and public hospitals in Western Australia for children who had at least one VTI from 1980 to 2004 was used to identify subsequent hospital admissions for cholesteatoma. Main outcome measures were time to cholesteatoma (survival) outcomes, including hazard ratios, log-rank tests, and Kaplan-Meier failure functions.

Results:

There were 45,980 children who underwent at least one VTI from 1980 to 2004 with 460 subsequently developing cholesteatoma. The cumulative percentage of children who developed cholesteatoma within 15 years after one VTI procedure was 0.9% (95% confidence interval [CI], 0.8–1.0), after two VTIs 2.1% (95% CI, 1.6–2.3), after three VTIs 3.8% (95% CI, 2.9–4.8), and after four or more VTIs 5.2% (95% CI, 4.0–6.7). The rate of developing cholesteatoma increased 10% (95% CI, 6–14) for each additional year in age before first VTI. For children who underwent two or more VTIs, the rate of cholesteatoma increased 21% (95% CI, 12–32) with each additional year between VTIs. Adenoid removal was associated with a 27% (95% CI, 11–40) reduction in the rate of developing cholesteatoma.

Conclusions:

Children with persistent or refractory middle ear disease who required multiple VTIs were at increased risk of cholesteatoma. First ventilation tubes inserted at an early age, subsequent ventilation tubes inserted without delay, and adenoid removal were associated with a reduced rate of cholesteatoma development. Laryngoscope, 2010

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