3-Pediatric cholesteatoma follow-up, why is it different than adult?

Pediatric vestibular medicine is a relatively new specialty, but has grown drastically in size and scope over the past couple of decades. Newer testing technologies have made testing feasible at progressively younger ages. Our understanding of the causes of vestibular symptoms in children and the role of vestibular testing in diagnosing them have also progressed significantly, allowing for better standardization and universalization of testing protocols. Vestibular testing may also play vital roles in determining candidacy for new therapies for pediatric hearing loss, such as cochlear implants for single sided deafness and gene therapy for congenital hearing loss. These advances make it essential for anybody caring for children with hearing loss in the modern era to have at least a basic understanding of the current indications, technologies, and approaches to vestibular testing in the pediatric age group. This symposium will be presented on behalf of the recently formed International Pediatric Balance Network (IBPN). It will include lectures and discussion from a group of pediatric vestibular specialists from around the world. Topics will include: 1.) “Remote Camera VHIT and the Advent of Newborn Vestibular Screening Programs”, 2.) “The Role of Vestibular Testing in Evaluating Pediatric Dizziness,” 3.) “Universal Guidelines for Pediatric Vestibular Testing in Congenital Hearing Loss,” and 4.) “New Roles of Vestibular Testing in Children: Single-Sided Deafness, Gene Therapy, and Beyond.” Attendees will learn about modern approaches to vestibular testing in children with and without hearing loss, as well as current and future indications for objective assessment of vestibular function in the pediatric population.

Description This round table is submitted by the European Pediatric Skullbase taskforce from ESPO. It will explore one of the most critical challenges in managing juvenile nasopharyngeal angiofibroma (JNA): residual disease. Despite advances in endoscopic resection and embolization, complete tumor removal remains complex, particularly in cases with skull base or intracranial extension. The session will focus on how optimal planning of the initial surgery—through imaging, staging, and multidisciplinary collaboration—can reduce residual risk. It will also examine the nuances of postoperative management: Should all residual tumors be reoperated? When is imaging surveillance appropriate? Are there non-surgical alternatives for indolent residual disease? Faculty will share decision-making algorithms, long-term outcomes, and illustrative cases to help define modern standards of care.

Outcome Objectives By the end of the session, participants will be able to:

1. Optimize the planning of initial JNA surgery to minimize residual disease.

2. Identify radiologic and intraoperative predictors of incomplete resection.

3. Differentiate between residual and recurrent disease using imaging and clinical criteria.

4. Evaluate the risks and benefits of reoperation versus surveillance.

5. Understand current and emerging alternatives to surgical reintervention for residual JNA.

Background Residual disease in JNA remains a source of clinical uncertainty, especially when the remnant is small, asymptomatic, or surgically risky. Incomplete resection may stem from intraoperative bleeding, complex tumor extensions, or the need to avoid critical neurovascular structures. Not all residual lesions behave aggressively; some remain stable for years. This symposium will provide a critical overview of strategies to reduce residual disease risk from the outset and explore evidence-based approaches to managing remnants. The discussion will help clinicians move beyond a binary “operate or not” framework toward a personalized, risk-adapted model of care.

Description This symposium explores the unique considerations and surgical strategies involved in managing skull base pathology in the pediatric population. While many principles of endoscopic skull base surgery are shared with adult practice, the pediatric context introduces specific challenges related to anatomy, instrumentation, and perioperative care. Experts will present structured talks on practical surgical techniques, including the management of pediatric cerebrospinal fluid (CSF) leaks and endoscopic repair of congenital meningoencephaloceles.

Outcome Objectives By the end of the session, attendees will be able to:

1. Understand the anatomical and physiological differences between pediatric and adult skull base surgery.

2. Identify appropriate adaptations in equipment, instruments, and theatre setup when operating in small children.

3. Apply specific technical strategies for managing pediatric CSF leaks, with emphasis on safety and long-term outcomes.

4. Recognize the diagnostic and surgical considerations for pediatric meningoencephaloceles.

5. Improve teamwork and communication between surgeons and assistants when working within the constraints of a small nasal cavity.

Background Pediatric skull base surgery remains a highly specialized and evolving field. Compared to adult patients, children present unique challenges due to smaller anatomical spaces, immature bone structures, and a narrower margin for error. Instrumentation must be adapted, and surgical teams require dedicated planning to ensure optimal access and safety. This symposium will provide practical guidance on operating within these constraints, including pearls on patient positioning, endoscope handling, and collaboration with surgical assistants.

Through illustrative cases and expert experience, the session will highlight advances in managing pediatric CSF leaks and congenital meningoencephaloceles—two conditions that exemplify the complexity and precision required in this age group. By sharing multidisciplinary insights, the symposium aims to equip attendees with a clearer understanding of how to safely expand their skull base practice into the pediatric realm.

Nearly 100 million children worldwide are affected by hearing loss, with congenital unilateral hearing loss diagnosed in up to 1 in 1,000 births in developed countries. Management of this condition varies significantly across the globe, influenced by factors such as resource availability, access to care, and ethical considerations.

Key challenges in managing congenital unilateral hearing loss include determining the appropriate timing and type of intervention, selecting the most suitable devices, and identifying the right candidates. Traditional outcome measures used for bilateral hearing loss may not fully capture the experiences or benefits for the children with unilateral hearing loss and consistent auditory input in one ear. For this population, additional metrics, such as quality of life, listening effort, and fatigue, must be considered.

This international expert panel will explore current global practices in managing congenital unilateral hearing loss and highlight key insights to inform shared decision-making with families.