EAONO/JOS Cholesteatoma Staging System and Correlation to Recurrence

Introduction: Acquired Cholesteatoma as a clinical entity can vary from a small keratin pearl to large lesions with complications involving the cranial vault. Given this range of disease, various staging systems have been created to categorize cholesteatoma into different classes however; there is little data to suggest prognostic factors. This study aims to analyze recurrence and recidivism using the EAONO/JOS Cholesteatoma staging system based on surgical approach

Methods: 65 patients with a diagnosis of primary acquired cholesteatoma who underwent surgical treatment were included. Operative notes and treatment course was reviewed, and cholesteatoma staged using the EAONO/JOS staging system. Baseline characteristics were analyzed using descriptive statistics. Chi-square and T-tests were used for categorical and continuous variables, respectively

Results: After exclusion criteria 67ears were analyzed. 60% were Stage 1, 61.2% were Stage 2, 32.8% were Stage 3, none were Stage 4. The recurrence rate at second look procedures was 53% for all ears and the average number of surgeries was 1. For Stage 1 Cholesteatoma, 25% underwent transcanal approach and 75% underwent CWU approach. For Stage 2, 83% underwent CWU, 7.3% underwent transcanal, and 9.8% underwent CWD. For Stage 3, 38% underwent CWU for initial management, and 61.9% underwent CWD (p < 0.002). Only ears with Stage 2 or 3 had a 5-year recurrence, however, overall the rates for Stage 2 (4.3%) and 25% for Stage 3

Conclusions: There was a higher rate of recurrence for stage 3 cholesteatomas than those with stage 2 cholesteatomas. This data may be useful guiding the otologic surgeon in counseling their patients with cholesteatoma on risks and benefits of different surgical approaches and risk of recurrence as well