EAONO/JOS Classification for Acquired Cholesteatoma – Evaluating the Impact of the Number of Affected Sites on Treatment and Outcomes

Introduction  The European and Japanese system for cholesteatoma classification proposed an anatomical differentiation in five sites. In stage I disease, one site would be affected and in stage II, two to five. We tested the significance of this differentiation by analyzing the influence of the number of affected sites on recidivism, hearing ability and surgical complexity.

Methods  Cases of acquired cholesteatoma treated at a single tertiary referral center between 2010-01-01 and 2019-07-31 were retrospectively analyzed. Recidivism was differentiated in residual disease or recurrence according to the system. For the analysis of the hearing outcomes, the air-bone gap mean of 0.5, 1, 2, 3 kHz (ABG) was considered. The surgical complexity was estimated considering the Wullstein’s tympanoplasty classification and the surgical approach (transcanal, canal up/down).

Results 513 ears (431 patients) were followed-up during 21.6 ± 21.5 months. 107 (20.9%) ears had one site affected, 130 (25.3%) two, 157 (30.6%) three, 72 (14.0%) four and 47 (9.2%) five. An increasing number of affected sites resulted in higher residual rates (9.4 to 21.3%, p=0.008) and surgical complexity, as well poorer ABG (preoperative 14.1 to 25.3 dB, postoperative 11.3 to 16.8 dB, p<0.001). These differences existed between the means of cases of stage I and II, but also when only considering ears with stage II classification.

Conclusion The data showed statistically significant differences when comparing the averages of ears with two to five affected sites, questioning the pertinence of the differentiation between stages I and II.

Publication History

Article published online:
12 May 2023