Predicting Recidivism for Acquired Cholesteatoma: Evaluation of a Current Staging System

Predicting Recidivism for Acquired Cholesteatoma: Evaluation of a Current Staging System:

Objective: Assess the utility and prognostic capabilities of the European Academy of Otology and Neurotology (EAONO) and Japanese Otological Society (JOS) cholesteatoma classification system, specifically for retraction pocket cholesteatoma. Study Design: Retrospective. Setting: Tertiary referral hospital. Patients: Adults and children with retraction pocket cholesteatoma. Interventions: Primary and planned second-look tympanoplasty with mastoidectomy. Main Outcome Measures: Incidence of recurrent or residual cholesteatoma at planned second-look surgery. Independent variables of age, gender, size of canal defect, and mucosa status were assessed. Additionally, the cholesteatoma classification, stage, and extent according to the EAONO/JOS system were recorded during the primary surgery. Results: A total of 125 cases were included. Twelve (9.6%) cases had recidivism over an average time of 7.5 months: the recurrence rate was 4% (n = 5), residual rate was 5% (n = 6), and one patient had both recurrent and residual disease (0.8%). Residual cholesteatoma occurred more frequently in children (p = 0.04, RR = 7.9 [1.0, 63.6]). Supratubal recess (S1) disease was associated with both recurrent cholesteatoma (p = 0.04, RR = 5.9 [1.3, 27.2]) and recidivism (p = 0.01, RR = 4.2 [1.5, 11.9]). Larger canal defects also showed an association with residual disease (p = 0.017). Conclusion: Younger patients and those with large ear canal defects tend to have residual disease at second-look surgery. Supratubal recess disease is also associated with recurrence. Despite the utility of the EAONO/JOS classification and staging system for cholesteatoma description and type, the prognostic value remains uncertain. Address correspondence and reprint requests to Simon Angeli, M.D., Director University of Miami Ear Institute, Department of Otolaryngology – Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136; E-mail: sangeli@med.miami.edu There are no sources of support or funding that require acknowledgement. The authors disclose no conflicts of interest. Copyright © 2020 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company