Objectives: To study the influence of the cochleariform process abutment (CPA) of early congenital cholesteatomas (CC) (ECCs) on surgical outcomes.
Study design: Retrospective case review.
Setting: University hospital otology referral clinic.
Patients: Two hundred consecutive pediatric ECC patients.
Interventions: The patients were classified into three groups based on the temporal bone computed tomography (TBCT) findings of ECC: A) the absence of CPA, B) the presence of CPA, and C) the presence of CPA and extension posterior to the malleus handle.
Main outcome measures: Residual CC according to each of the TBCT and surgical stages during 34.9 ± 20.1 months of follow-up.
Results: Group A was significantly associated with effortless delivery without matrix tearing (77%) even with simple myringotomy. Only 17% of group B experienced this outcome, and troublesome matrix tearing occurred in significantly more patients (p < 0.0001). Residual CCs were present in 17.5% of group B if matrix tears occurred, which was comparable to group C (22.0%) and significantly greater than group A (4.4%, p = 0.03). Normal hearing was preserved in 97.5% of the ECC patients both when the ECCs did not recur and when they recurred without CPA. However, residual ECCs with positive CPAs in five children (2.5%) required ossicle removal, and subsequent hearing loss.
Conclusions: CPA is directly related to intraoperative matrix tear or increased recidivism, that CPA should be the landmark to distinguish stage II ECC from stage I. Surgeons should evaluate CPA on preoperative TBCTs of ECC patients, and restrict myringotomy approach to CPA negative ECC.