Introducing the “ChOLE” Classification and Its Comparison to the EAONO/JOS Consensus Classification for Cholesteatoma Staging

Abstract

Many previous attempts have been made to classify or categorize cholesteatomas. Recently, the European Academy of Otology and Neurotology and the Japanese Otological Society proposed a classification system based primarily on extension and complications. The European Academy of Otology and Neurotology/Japanese Otological Society consensus statement makes an effort to standardize reporting of surgical techniques. Internet-based multicenter studies are facilitated by increasing connectivity, but a mutually-agreed framework for reporting is necessary for results to be comparable across sites. New technologies compete with established standardized surgical approaches and need to be validated. It is definitively the right time to find a consensus on how to record and report surgical findings in cholesteatoma surgery. To stimulate this interesting discussion, we propose a ChOLE-classification system, which is based on the differentiation into extension (Ch), status of the ossicular chain at the end of surgery (O), complications (L), and degree of pneumatization and ventilation (E). A numeric rule is used to stage these cholesteatomas from I-III.

A Retrospective Analysis and Comparison of the STAM and STAMCO Classification and EAONO/JOS Cholesteatoma Staging System in Predicting Surgical Treatment Outcomes of Middle Ear Cholesteatoma

“…9, origin and location of disease (10), direction of extension (11,12), and radiological findings (13). More recently, Linder et al (14) proposed a classification system based on extension of cholesteatoma, postoperative ossicular chain status, complications and degree of pneumatization and ventilation. However, until now none of these classification systems has been widely adopted.…”

Mapping the ChOLE classification to hearing outcomes and disease-specific health-related quality of life

“…Surgical classification of cholesteatoma was performed using the ChOLE classification consisting of four subdivisions [15]. Cholesteatomas are classified by (1) extension with subdivisions Ch1 describing limited extension within the middle ear to Ch4 describing a petrous apex cholesteatoma, (2) status of the ossicular chain at the end of surgery with O0 indicating an intact ossicular chain to O4 indicating a fixed stapes only, (3) complications with L2 describing extracranial and L4 describing intracranial complications, and (4) Eustachian tube function as determined by the degree of mastoid pneumatization and ventilation with E0 indicating a good to E2 indicating a poor pneumatization and ventilation.…”

“…Yet, a novel comprehensive classification system has been recently developed, i.e. the ChOLE classification [15]. The ChOLE classification has several advantages over existing classification.…”

Distribution of different morphological types of anterior epitympanic plate “cog” and Köerner’s septum in CT images of cholesteatomatous and non-cholesteatomatous CSOM: is it really significant?

“…Surgeons and radiologists have made several attempts to classify cholesteatoma [2,4]. The most widely used classifications are based mainly on either their pathogenesis (congenital or acquired) or on their location in the middle ear cavity in relation to the TM [1,5].…”

“…The most widely used classifications are based mainly on either their pathogenesis (congenital or acquired) or on their location in the middle ear cavity in relation to the TM [1,5]. Recently, the "European Academy of Otology and Neuro-otology" and the "Japanese Otological Society" proposed a new classification system based primarily on extension and complications [4].…”