gms | German Medical Science

Background: The EAONO/JOS staging system (EJSS) classifies cholesteatoma according to the number of sites involved, with one site leading to stage I and 2 to 5 sites leading to stage II. We tested the significance of this differentiation by analyzing the complexity of cholesteatoma involvement for the 5 most common localizations on hearing ability, surgical complexity and residual disease.

Materials and methods: Cases of acquired cholesteatoma treated at a single tertiary referral center between 2010-01-01 and 2019-07-31 were classified according to the EJSS retrospectively. The mean air–bone gap served as hearing outcome. The surgical complexity was estimated regarding the Wullstein’s tympanoplasty classification and the surgical approach.

Results: 352 ears were followed-up during the mean follow-up time of 22.94 ± 22.21 months. With 111 cases (31,5%), TAM was the most frequent localization, followed by TA (73 cases; 20,7%), A (70 cases; 19,9%), S1S2TAM (50 cases; 14,2%) and S2TAM (48 cases; 13,6%). An increase in the complexity of cholesteatoma involvement resulted in higher surgical complexity, higher frequency of second-look operations as well as poorer ABG. No difference was found for the recidivism rate, neither for residuum nor for the recurrence.

Conclusion: Considering the EJSS classification system for the five most common localizations, data showed that more complex cholesteatoma involvement influences hearing outcomes, surgical complexity and the frequency of second-look operations. The results support the need for the further refinement of the purposed differentiation in stages I and II.