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Updated: Oct 13, 2026
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Incidence and Clinical Characteristics of Sniff-related Cholesteatoma: A Prospective, Multicenter, Observational
Shiori Endo1, Toshimitsu Kobayashi2, Kunihiro Mizuta3
1Ear Surgery/Eustachian Tube Center, Shizuoka Saiseikai General Hospital, Shizuoka, Japan.
Objective:
Habitual sniffing resulting from insufficient Eustachian tube closure is an important etiologic factor in the development and postoperative recurrence of pars flaccida cholesteatoma. In this study, we aimed to investigate the prevalence and clinical characteristics of cholesteatoma associated with habitual sniffing (sniff-related cholesteatoma) among patients with surgically indicated pars flaccida cholesteatoma.
Study Design:
Prospective, multicenter, observational study.
Setting:
Twenty-six tertiary otologic referral centers.
Patients:
A total of 128 consecutive patients aged 15 years or above with newly diagnosed pars flaccida cholesteatoma (stage Ib or higher according to the Japan Otological Society staging system) were included.
Interventions:
None.
Main Outcome Measures:
The primary outcome was the prevalence of sniff-related cholesteatoma among patients with surgically indicated pars flaccida cholesteatoma. Patients were classified into 3 groups based on the presence of habitual sniffing episodes and the results of the sniffing test: sniff-related cholesteatoma (both positive), non-sniff-related cholesteatoma (both negative), and others. Demographic and clinical characteristics, including age and sex, were compared among the 3 groups.
Results:
Among the 128 patients, 53 (41.4%) were classified as having sniff-related cholesteatoma. Furthermore, patients in the sniff-related cholesteatoma group were significantly younger than those in the non-sniff-related group.
Conclusions:
Approximately 40% of patients with surgically indicated pars flaccida cholesteatoma had sniff-related cholesteatoma, suggesting an association with insufficient Eustachian tube closure. The careful assessment of habitual sniffing may be essential for elucidating disease pathophysiology and optimizing treatment strategies, including postoperative management.
