Consensus-Based Recommendations on the Definition and Classification of Cholesteatoma.

Development of a consensus on the definitions and classification of cholesteatoma is essential for scientific community to exchange information on clinical studies and compare their outcomes. The aim of the study is to reach a consensus among members of the European Academy of Otology and Neurotology (EAONO) regarding the definitions and classification related to cholesteatoma. A set of statements was developed by the authors utilizing the literature on the definition and classification of cholesteatoma. A questionnaire was sent to the members of the EAONO, inviting them to state if they are in agreement with each of the statements and if not, then to provide comments or suggestions for revision. Responses were evaluated and modified using online questionnaire and survey software based on the Delphi technique, a cyclical process of gathering information, summarizing, and re-submitting the revised statements to the same target population until a consensus is reached. Target agreement among the responders was set at a minimum of 80%, and the cycle of revision and re-submission of the statements were repeated until a consensus was reached on a majority of the statements. A steering group has been established to evaluate the results of the survey and worked via the process of cognitive debriefing. Out of 364 EAONO members, 123 responded to the first consensus cycle, 77 to the second cycle, and 53 to the third cycle. After three cycles, all statements concerning cholesteatoma definitions reached the target of 80% consensus. However, a consensus on the classification of cholesteatoma could not be achieved. The steering group excluded four statements of cholesteatoma definition and established a consensus on cholesteatoma classification. A consensus on cholesteatoma definitions was reached among the members of the EAONO. The final revision on consensus statements for cholesteatoma definition and classification has been made via the process of cognitive debriefing of the steering group.