Staging system for cholesteatoma

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About ChOLE

The “ChOLE” classification has evolved over the past several years through repeated evaluation using our 15-year prospective ENTstatistics database.

Whereas “ChOLE” is an acronym for classifying the disease, our staging has a numeric definition calculated from the individual ChOLE scores.

The initial official presentation of the “ChOLE” classification was given at the international cholesteatoma conference in Edinburgh in 2016. At the same time, the European Academy of Otology and Neurotology (EAONO) and the Japanese Otological Society (JOS) proposed another classification system based primarily on extension and complications.

We also suggest to use the SAMEO-ATO middle ear surgery classification system (PDF overview, PDF publication).

We propose a ChOLE-classification system, which is based on the differentiation into

  • Ch — cholesteatoma extension
  • O — status of the ossicular chain at the end of surgery
  • L — complications
  • E — degree of pneumatization and ventilation as an indirect sign of Eustachian tube function

A numeric rule is used to stage these cholesteatomas from I-III.

The official publication on the “ChOLE” classification is online with open access:

Otol Neurotol. 2018 Oct 18. doi: 10.1097/MAO.0000000000002039. [Epub ahead of print]

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

Linder TEShah SMartha ASRöösli CEmmett SD.

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