Correlation Between Surgical Outcome and Stage of Acquired Middle Ear Cholesteatoma: Revalidation of the Chole Staging System

The aim of the study is to assess and correlate the stage of cholesteatoma with its surgical outcome using the ChOLE classification, and thus revalidate it. Study Design: This was a prospective, observational study conducted in the Department of ENT, Head and Neck Surgery at SRIHER from Dec 2020 to Dec 2022. Sample Size: A total of 73 patients with acquired cholesteatoma. Out of the 73 patients, 15 patients (20.5%) were classified as stage I, 53 patients (72.6%) as stage II, and 5 patients (6.8%) as stage III. All patients with ChOLE I underwent canal wall up procedures, with specific approaches including cortical mastoidectomy with atticoantrostomy in 11 patients, inside-out mastoidectomy with transcanal approach in 3 patients, and post-aural approach in 1 patient. For ChOLE II patients, 19 underwent canal wall lowering, while the remaining 34 had canal wall up procedures, with 21 undergoing inside-out mastoidectomy with a post-aural approach. Among the 5 stage III patients, 4 underwent canal wall down mastoidectomy. Post-operative hearing outcomes showed significant improvements in ChOLE I and II stages, with pre-operative AC PTA and post-operative AC PTA p-values of 0.001 and 0.07, respectively. The pre-operative and post-operative ABG was significant only in ChOLE I. There was a trend of increasing ABG towards ChOLE III. Overall, hearing outcomes were good for all patients, with significant improvements in AC and ABG (p < 0.01). The ChOLE classification system is a valuable new reporting tool for surgical management and hearing outcomes of cholesteatoma. It can be used to prognosticate outcomes, making it useful for pre-operative patient counseling and managing expectations.