Evaluating hearing outcome, recidivism and complications in cholesteatoma surgery using the ChOLE classification system

• DOI: 10.1007/s00405-020-06208-z
• Publication Date: 2020-07-13T22:02:54Z
• Authors: David Bächinger; Adrian Rrahmani; Nora M. Weiss; Robert Mlynski; Alexander Huber; Christof Röösli
• Keywords: Adult; Cholesteatoma, Middle Ear; 610 Medicine & health; 10045 Clinic for Otorhinolaryngology; Otology; General Medicine; 3. Good health; 03 medical and health sciences; 2733 Otorhinolaryngology; Treatment Outcome; Tympanoplasty; 0302 clinical medicine; Otorhinolaryngology; Hearing; Recidivism; Audiometry, Pure-Tone; Humans; Prospective Studies; Retrospective Studies

Abstract Purpose To establish a standardized reporting system of cholesteatoma, the ChOLE classification has recently been introduced. We here aimed to systematically investigate the association between the ChOLE classification and (i) hearing, (ii) recidivism rate, and (iii) postoperative complications. These data may increase the utility of the ChOLE classification in clinical practice and research by stratifying patients according to expected outcomes or risks for complications.

Methods In this prospective multicentric study, we included adult patients undergoing tympanomastoid surgery due to cholesteatoma. Main outcome measures included the association of the ChOLE classification system with (i) audiometric data including air conduction (AC) and bone conduction (BC) pure-tone average (PTA), and the air–bone gap (ABG), (ii) recidivism and complication.

Results A total of 160 patients suffering from cholesteatoma were included. ChOLE stage distribution was stage I in 23 (14%), stage II in 128 (80%), and stage III in 9 (6%) patients. The ChOLE stage was associated with the postoperative AC PTA (p = 0.05) and the postoperative BC PTA (p = 0.02). Further, the status of the ossicular chain after surgery (ChOLE subdivision “O”) was associated with both the postoperative ABG (p = 0.0001) and the postoperative AC PTA (p = 0.003). Moreover, we found an association between complications (ChOLE subdivision “L) and both the postoperative BC PTA (p = 0.04) and the postoperative ABG (p = 0.04). No association between the ChOLE stage was found to both cholesteatoma recidivism and surgical complications.

Conclusion The ChOLE classification is a new system to classify cholesteatomas. We provide evidence that hearing outcomes vary among different ChOLE stages. In particular, hearing outcomes are associated with the ChOLE subdivision “O” and “L”. Thus, the ChOLE classification system has a predictive value regarding hearing outcomes.