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)

ChOLE tool, (1) Four ChOLE classifications, (2) classification values.

Explanations

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

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.