[Staging of middle ear cholesteatoma surgery and its value for clinical decision-making]

Middle ear cholesteatoma is characterized by squamous epithelial accumulation within the middle ear cavity, which can lead to severe complications such as hearing loss, facial nerve paralysis, and intracranial infection. A scientific staging system is essential for guiding surgical planning and improving the comparability of clinical research. This review systematically examines the main classification frameworks and their core principles, evaluating evidence regarding preoperative applicability, interobserver reliability, and impact on clinical decision-making. Although existing systems each have strengths, none simultaneously achieves high preoperative applicability and accurate prognostic stratification. Future work should focus on preoperative staging using combined HRCT and MRI, supported by multicenter validation of reproducibility, and should incorporate artificial intelligence-assisted assessment to enhance the utility of staging in surgical planning and follow-up management.