CC BY-NC-ND 4.0 · Laryngorhinootologie 2019; 98(S 02): S304-S305
DOI: 10.1055/s-0039-1686327

A new emerging grading score for middle ear cholesteatoma

M Ahmed
1   Sohag University, Sohag, EGYPT
R Sayed
2   Otorhinolaryngology department, Sohag faculty of Medicine, Sohag University, Egypt, Sohag, Egypt
ME Ahmed
3   Otorhinolaryngology department, Sohag faculty of Medicine, Sohag University, Egyp, Sohag, Egypt
S Nakata
4   Otolaryngology department, Fujita Health University, Second Affiliated Hospital, Nagoya, Aichi, Nagoya, Japan
› Author Affiliations


Cholesteatoma is a non-tumorous destructive lesion of the temporal bone with a characteristic progressive bone resorption activity that can lead to many complications. Grading of cholesteatoma invasiveness is crucial for prognostic and operative implications. Many scoring systems were employed but most of them have not gained universal or worldwide approval. In this work, we have suggested new scoring and grading system for human acquired tympanomastoid cholesteatoma.


our system depends upon counting the number of resorbed bones seen radiologically and confirmed intraoperatively putting in mind complicated cases as the highest score for each bone specifically. Bony structures included were scutum, auditory ossicles, tegmen, facial canal, sinus plate, posterior canal wall, mastoid and inner ear. A previous immunochemical study done by the authors used this system to predict cholesteatoma aggressiveness.


Scoring was suggested from 0 to 15. Cholesteatoma was categorized into two groups; non-invasive [score 0 to 3] and invasive one [score 4 to 15]. We suggest the non-invasive group would be less liable to produce complications and could be managed by conservative surgery whereas invasive group would carry the risk of complications and need radical surgery.


we have suggested a new scoring system for cholesteatoma aggressiveness. It is easy applicable, more decisive and strictly objective. However, larger studies with clinical correlation of this system is highly recommended in order to gain wide acceptance.

Publication History

Publication Date:
23 April 2019 (online)

© 2019. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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