ChOLE rules

Get the ChOLE classification/stage with 4 clicks: simply choose one value per classification. The sum of scores determines the ChOLE stage.

ChOLE classifications

Ch – Cholesteatoma extension
O – Ossicular chain status (at the end of surgery)
L – Life threatening complications
E – Eustachian tube ventilation and mastoid pneumatisation

Staging classification

Stage I – sum of classification values between 1 and 3 points
Stage II – sum of classification values between 4 and 8 points
Stage III – sum of classification values over 8 points

If at least one of the classifications (Ch, O, L, E) is not identifiable / not specified the Stadium leads to a “x” postfix (Ix, IIx, IIIx)

Explanatory notes

Ch – Cholesteatoma extension

ChX – Not identifiable (not specified)
Ch1a – Middle ear cavity and/or limited extension towards the epitympanum (e.g. pars flaccida)
Ch1b – Middle ear cavity and/or limited extension towards the epitympanum (e.g. pars flaccida) + sinus tympani
Ch2a – Middle ear with extension into the attic and mastoid (up to the lateral canal)
Ch2b – Middle ear with extension into the attic and mastoid (up to the lateral canal) + supratubal space/Eustachian tube and/or sinus tympani
Ch3 – Stage 2a or 2b + wide exposure into the mastoid and/or extensive canal wall destruction
Ch4a – Supra- or infralabyrinthine extension of tympanomastoid cholesteatoma
Ch4b – Petrous apex cholesteatoma Medial to otic capsula

O – Ossicular chain status (at the end of surgery)

OX – Not identifiable (not specified)
O0 – Ossicular chain intact
(Austin-Kartush class 0)
O1 – Malleus (with or without malleus head) and stapes present
(Austin-Kartush class A, Fisch I)
O2 – Malleus and footplate only
(Austin-Kartush class B, Fisch II1)
O3a – Stapes only
(Austin-Kartush class C, Fisch III1 or III4)
O3b – Mobile Footplate only
(Austin-Kartush class D, Fisch III2 or III5)
O4a – Fixed stapes only
(similar to Austin-Kartush class F, Fisch III3 or III6)
O4b – Footplate only and fixed
(similar to Fisch III3 or III6)

L - Life threatening complications

LX – Not identifiable (not specified)
L2 – Mastoiditis, Mastoid fistula, Bezold’s or Luc’s abscess, Facial palsy, Labyrinthine fistula, Labyrinthitis or Tegmen defect requiring surgical repair
L4 – Meningitis, Brain abscess, Seizures or Sigmoid sinus thrombosis

E - Eustachian tube ventilation and mastiod pneumatisation

EX – Not identifiable (not specified)
E0 – > 50 % of cells aereated
E1 – < 50 % of cells aereated
E2 – Poor pneumatisation and ventilation

ChOLE app features and usage

The key features of the ChOLE web application are:

4 steps: Get the ChOLE classification and stage with 4 clicks. Choose a value per classification.
Copy to clipboard: Copy the classification and stage into the clipboard of your device, so that you can paste it in any other program.
Explanation text: For most buttons an extended explanation can be displayed. Let the cursor rest on the info icon.
Image details: The images can be viewed in a bigger version, so that you can see more of the details.
Smartphone and tablet: The app is designed in a way that you can also use it on your smartphone or tablet as well.

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Open Safari. Other browsers, such as Chrome, won’t work.
Navigate to https://app.chole.surgery
Tap the Share button at the bottom of the page.
On the bottom row of icons, scroll over until you see Add to Home Screen and tap this.

Open Chrome (usually your default web browser on Android)
Navigate to https://app.chole.surgery
Tap the three-dot menu button in the top-right corner and choose Add to Home Screen.
Just tap ADD when you’re ready.