Outcomes of Primary Acquired Cholesteatoma Managed with Endoscopic-Microscopic Approaches According to EAONO-JOS and...

To assess the utility of the European Academy of Otology and Neurotology-Japanese Otological Society (EAONO-JOS) and SAMEO-ATO tympanomastoid surgery classification systems in predicting recidivistic disease in patients with primary acquired cholesteatoma and to compare outcomes between endoscopic and combined approaches.

Retrospective chart review.

Academic teaching hospital.

Eighty-one surgical ears from 77 patients were operated on between 2015 and 2022 by the senior author and fit the inclusion criteria. Surgeries were retrospectively classified according to SAMEO-ATO and EAONO-JOS classifications. Descriptive statistics for staging and demographics were reported. Multivariate analysis was completed to assess the correlation between EAONO-JOS and SAMEO-ATO classification and residual disease with covariates including age. The incidence of residual and recurrent disease was investigated using Kaplan-Meier survival analysis. Patients had a median follow-up of 36.7 months.

Based on EAONO-JOS staging, 13.6% of ears were stage I, 65.4% were stage II, 21.0% were stage III, and 0% were stage IV. Exclusive endoscopic approaches (A1Mx, A1M2a, and A1M2b) were performed in 50.6% of all ears, and combined approaches (A4M1a, A4M1b, A4M1a + M2a, and A4M2c) in the remaining 49.4% of ears. Overall residual disease rate was 41.9% (n = 34), while recurrence occurred in 7.4% (n = 6). In Kaplan-Meier analysis, SAMEO-ATO and EAONO staging did not predict residual or recurrent disease. In multivariate analysis, age was correlated with a lower risk of residual disease for each advancing year (HR 0.97, 95% CI = 0.95-0.99, p < 0.01). Compared to combined approaches during primary surgery, exclusive endoscopic approaches were correlated with lower conversion to CWU or CWD mastoidectomy for revision surgery (HR 0.19, 95% CI = 0.05-0.71, p = 0.014).

In this cohort of patients with primary acquired cholesteatoma, predominantly EAONO-JOS stage II and III, half were managed with an exclusive transcanal endoscopic approach. Although EAONO-JOS and SAMEO-ATO did not predict recidivism, the classification is an important starting point for maintaining uniformity in collecting outcomes. The study was limited by a small sample size and limited follow-up duration.