Chronic otitis media with cholesteatoma - is it possible to predict the postoperative outcomes?

Introduction: In 2017, the European Academy of Otology and Neurotology (EAONO) published a consensus statement in cooperation with the Japan Otological Society (JOS) that unified the definition, classification and staging of the middle ear cholesteatoma. It was intended to help determine the severity of the disease, difficulty of complete removal, and to make it easier to compare surgical outcomes between different centers. The classification defines 5 regions within the middle ear (the so-called STAM system): S - difficult access sites (S1 - protympanum/anterior epitympanum/supratubal recess, and S2 - sinus tympani), T - tympanic cavity, A - attic, and M - mastoid process. This consensus also distinguishes 4 stages of cholesteatoma (STAGE I-IV) depending on the local extent of the cholesteatoma or the presence of extracranial or intracranial complications.Aim: The aim of this study was to analyze patients with chronic otitis media with cholesteatoma, to assess the treatment outcomes, and to correlate it with the stage of the disease according to the EAONO/JOS classification.Material and methods: We conducted a retrospective analysis of the medical records of patients undergoing the first surgery for chronic otitis media with cholesteatoma between 2015 and 2020. The study group consisted of 204 patients aged 6-82, including 113 males and 91 females.Results: The analysis showed a statistically significant relationship between the disease stage and erosion of the malleus (p = 0.00342), the incus (p = 0.0001) and the stapes suprastructure (p = 0.00193). The highest cholesteatoma recurrence rate was observed following its removal accessed through the external ear canal alone. It was less common after a closed tympano-plasty (canal wall up, CWU) and even less frequent after open tympanoplasty (canal wall down, CWD). Very good results were also found in patients after surgery with mastoid process obliteration (bony obliteration tympanoplasty, BOT). In contrast, no correlation between the cholesteatoma recurrence rate and the stage of the disease was observed in the studied group (p = 0.53430). The statistical analysis showed that, as the disease progressed through stages I-III, the preoperative hearing loss for air conduction (p = 0.0025) and for bone conduction (p = 0.0042), as well as the air-bone gap (p = 0.0201) were signi-ficantly higher. Also, the analysis of the postoperative hearing results showed that all the values were higher in advanced stages of the disease, and the differences were statistically significant (p = 0.0156 for air conduction, p = 0.0069 for bone conduction, respectively). Conclusions: Our study showed that the classification by EAONO/JOS helps objectively determine the stage of the disease, which in turn correlates with the degree of bone destruction and with hearing results. It also provides an opportunity to com-pare treatment outcomes with other researchers. However, this system does not predict the risk of cholesteatoma recurrence based only on its location and staging. The operative technique which was used seems to be the key factor.