Assessing the Prognostic Value of the ChOLE Classification in Predicting the Severity of Acquired Cholesteatoma

Eggink, Maura C; Wolf, Maarten J. F. de; Ebbens, Fenna A.; Dikkers, Frederik G.; Spronsen, Erik van

doi:10.1097/mao.0000000000003501

Cited by 5 publications

(4 citation statements)

References 32 publications

(51 reference statements)

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“…When comparing the recidivism rates of cholesteatoma after surgery, results are often inconsistent depending on the statistical analysis method (5)(6)(7)(8). In a report by Stangerup et al (3), the survival rate by period, obtained by calculating the "number of survivors divided by the number of eligible patients" by period, showed that the recidivism rate of cholesteatoma at 8 years postoperatively was 30%.…”

Section: Discussionmentioning

confidence: 99%

“…The report presented by Møller et al (6) showed the cumulative recidivism-free rates of 1,060 postoperative cholesteatomas using the Kaplan-Meier method for each operation. The report presented by Eggink et al (7) assessed the prognostic value of the ChOLE classification in predicting the severity of acquired cholesteatoma using the Kaplan-Meier method. We have included three new points in our report after comparing them with these previous reports.…”

Section: Discussionmentioning

confidence: 99%

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Time Analysis of Recidivism in Acquired Cholesteatoma Using the Kaplan-Meier Method

et al. 2023

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Objective:To analyze the time trends of recidivism of acquired cholesteatoma using the Kaplan-Meier method. Study Design: We conducted a retrospective, observational study of 256 patients having their first cholesteatoma surgery. The cumulative recidivism-free rate was calculated using Kaplan-Meier survival analysis related to the follow-up period, pathophysiology, the extent of the disease, and recidivism pathologies. Results: Pars flacida cholesteatoma with tympanic cavity progression had a high likelihood of recurrence disease. Pars tensa cholesteatoma led to more recurrence of the disease than the residual disease. In both pars flacida and pars tensa cholesteatoma, the incidence of disease recurrence increased even 3 years after surgery. On the contrary, the incidence of residual disease peaked within 3 years after surgery, and thereafter, the incidence of residual disease tended to be small. In particular, pars flacida cholesteatoma extending into the mastoid cavity or tympanic cavity tended to recur up to 5 years postoperatively. Conclusions: We calculated the cumulative recidivism-free rates of 256 patients with cholesteatoma using Kaplan-Meier survival analysis. These results can lead to better estimates of the length of the follow-up period. Level of Evidence: Level IV evidence from case-control studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Time Analysis of Recidivism in Acquired Cholesteatoma Using the Kaplan-Meier Method

et al. 2023

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“…As a result of this, it could be more difficult to compare our research to other studies. Cholesteatoma classification may also be prognostically relevant, although this has recently been challenged by Eggink et al [ 36 , 37 ]. Second, we did not compare our results with a cohort without obliteration due to differences in follow-up protocols in our center.…”

Section: Discussionmentioning

confidence: 99%

Cholesteatoma surgery in the pediatric population: remaining challenges in the era of mastoid obliteration

Kroon

Mes

Borggreven

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose To present the first pediatric study on the safety and efficacy of mastoid obliteration using S53P4 bioactive glass (BAG) for cholesteatoma surgery. Methods A single-center retrospective cohort study was conducted. Inclusion criteria were pediatric cases (≤ 18 years) and at least at least one year of follow-up including non-echo planar diffusion-weighted MRI to assess cholesteatoma recidivism. Both canal wall up (CWU) and canal wall down (CWD) procedures were evaluated. Results A total of 61 cases (56 patients) were included. Most cases had an otologic history before the development of the cholesteatoma. CWU procedure was performed in 18 cases (30%) and CWD procedure in 43 cases (70%). The cholesteatoma recidivism rate was 33% after a mean follow-up period of 58 months. Kaplan–Meier curve estimated a 5-year recidivism rate of 40%. Few complications were seen that were all minor and resolved spontaneously or after local or systemic treatment. Control of the infection (merchant grade 0–1) was achieved in 98% of the cases. Closure of the air–bone gap within 20 dB was achieved in 22% of the cases with complete audiometric evaluation. Conclusion In this MRI-controlled study, we show the safety and efficacy of S53P4 BAG for mastoid obliteration in a pediatric cholesteatoma cohort. Postoperative complications were both rare and minor, and a dry ear was achieved in almost all patients. Nevertheless, persistent hearing loss and the apparent high recidivism rate reflect the challenging nature of pediatric cholesteatoma.

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“…Cholesteatomas are benign collections of keratinized squamous epithelium, mostly found within the middle ear; however, they are an intractable chronic proliferative disease that can cause fatal complications, such as bone destruction and brain abscesses. The only treatment option is surgery, and the long-term recurrence rate is reported to be as high as approximately 20–60% [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Recurrence rates vary widely depending on the method of statistical analysis and period of observation, making it difficult to determine the optimal strategy for selecting a procedure.…”

Section: Introductionmentioning

confidence: 99%

Augmented Reality-Assisted Transcanal Endoscopic Ear Surgery for Middle Ear Cholesteatoma

Tsuchida,

Takahashi,

Nakazawa

et al. 2024

JCM

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Background: The indications for transcanal endoscopic ear surgery (TEES) for middle ear cholesteatoma have expanded for cases involving mastoid extension. However, TEES is not indicated for all cases with mastoid extension. In addition, predicting the extent of external auditory canal (EAC) removal needed for cholesteatoma resection is not always easy. The purpose of this study was to use augmented reality (AR) to project the lesion onto an intraoperative endoscopic image to predict EAC removal requirements and select an appropriate surgical approach. Methods: In this study, patients showing mastoid extension were operated on using a navigation system with an AR function (Stryker). Results: The results showed that some cases with lesions slightly extending into the antrum required extensive resection of the EAC, while cases with lesions extending throughout the antrum required smaller resection of the EAC, indicating TEES. Conclusions: By predicting the extent of the needed EAC removal, it is possible to determine whether TEES (a retrograde approach) or canal wall-up mastoidectomy, which preserves as much of the EAC as possible, should be performed. We believe that our findings will contribute to the success of middle ear surgeries and the implementation of robotic surgery in the future.

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Assessing the Prognostic Value of the ChOLE Classification in Predicting the Severity of Acquired Cholesteatoma

Cited by 5 publications

References 32 publications

Time Analysis of Recidivism in Acquired Cholesteatoma Using the Kaplan-Meier Method

Time Analysis of Recidivism in Acquired Cholesteatoma Using the Kaplan-Meier Method

Cholesteatoma surgery in the pediatric population: remaining challenges in the era of mastoid obliteration

Augmented Reality-Assisted Transcanal Endoscopic Ear Surgery for Middle Ear Cholesteatoma

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