ChOLE-Based Stratification of Cholesteatoma Surgery: Predictive Value for Recurrence and Hearing Recovery

Area of Science:

• Otolaryngology
• Surgical Classification Systems
• Audiology

Background:

• Cholesteatomatous chronic otitis media presents complex clinical challenges.
• Accurate classification systems are crucial for predicting surgical outcomes and recurrence.
• The ChOLE system integrates cholesteatoma extension, ossicular status, and complications.

Purpose of the Study:

• To evaluate the clinical and hearing outcomes of cholesteatoma surgery using the ChOLE classification.
• To assess the ChOLE system's utility in predicting recurrence, guiding surgical approach, and anticipating hearing recovery.
• To compare early and late postoperative hearing results.

Main Methods:

• Retrospective analysis of 130 patients (141 ears) undergoing cholesteatoma surgery (2011-2020).
• Classification of patients using the ChOLE criteria (cholesteatoma extension, ossicular chain status, life-threatening complications).
• Comparison of surgical techniques, recurrence rates, and audiological outcomes (early and late follow-up).

Main Results:

• Stage II was the most frequent ChOLE stage (74.4%).
• Canal wall-down (CWD) surgery was more common in advanced stages (II and III).
• Ossicular chain status significantly impacted hearing outcomes; advanced stages showed poorer results.
• Long-term hearing success (24.8% air conduction, 31.2% hearing gain) surpassed early results.

Conclusions:

• The ChOLE classification system effectively guides surgical strategy and predicts functional outcomes in cholesteatoma surgery.
• Greater cholesteatoma extension and advanced stage correlate with more extensive surgery and poorer hearing results.
• Standardized ChOLE reporting enhances consistency and comparability across studies, with long-term follow-up crucial for assessing success.