Keiji Matsuda1, Tetsuya Tono2, Hiromi Kojima3, Yutaka Yamamoto4, Masafumi Sakagami5, Yasuo Mishiro6, Yasuyuki Hinohira7, Taeko Okuno8. 1. Department of Otorhinolaryngology - Head & Neck Surgery, University of Miyazaki, Japan. Electronic address: kmatsuda@med.miyazaki-u.ac.jp. 2. Department of Otorhinolaryngology - Head & Neck Surgery, University of Miyazaki, Japan. Electronic address: tono@med.miyazaki-u.ac.jp. 3. Department of Otorhinolaryngology, Jikei University School of Medicine, Japan. Electronic address: kojimah@jikei.ac.jp. 4. Department of Otolaryngology Head and Neck Surgery, Niigata University Faculty of Medicine, Japan. Electronic address: entyama@jikei.ac.jp. 5. Department of Otorhinolaryngology - Head and Neck Surgery, Hyogo College of Medicine, Japan. Electronic address: msakaga@hyo-med.ac.jp. 6. Department of Otorhinolaryngology - Head and Neck Surgery, Hyogo College of Medicine, Japan. Electronic address: ymishiro@hyo-med.ac.jp. 7. Department of Otorhinolaryngology, Showa University School of Medicine, Kamio Memorial Hospital, Japan. Electronic address: hinohira@med.showa-u.ac.jp. 8. Department of Otorhinolaryngology, Mitsui Memorial Hospital, Japan. Electronic address: tokuno503@gmail.com.
Abstract
OBJECTIVE: The Objective of this study was to assess the practicality of the cholesteatoma staging system proposed by the Japan Otological Society (JOS) for acquired middle ear cholesteatoma (the 2010 JOS staging system). METHODS: Between 2009 and 2010, 446 ears with retraction pocket cholesteatoma underwent primary surgery at 6 institutions in Japan. The extent of cholesteatoma was surgically confirmed, and classified into three stages. RESULTS: The cholesteatoma affected the pars flaccida in 325 ears (73%), the pars tensa in 100 ears (22%), and both regions combined in 21 ears (5%). The hearing outcome (postoperative air-bone gaps dB) worsened as follows (Stage I, II, III): 84%, 68%, 53% in pars flaccida; 71%, 62%, 30% in pars tensa, and 42% at Stage II, and 50% at Stage III in the combined group. The incidence of residual cholesteatoma increased as follows (Stage I, II, III): 2%, 12%, 23% in pars flaccida; 7%, 30%, 21% in the pars tensa group. The severity of disease was reflected in postoperative hearing and increasing incidence of recurrence rate. CONCLUSION: The 2010 JOS staging system is suitable for evaluating initial pathology. It is particularly practical for standardizing reporting of retraction pocket cholesteatoma and for adjusting for the severity of the condition during outcome evaluations. It may also provide information that is useful for counseling patients.
OBJECTIVE: The Objective of this study was to assess the practicality of the cholesteatoma staging system proposed by the Japan Otological Society (JOS) for acquired middle ear cholesteatoma (the 2010 JOS staging system). METHODS: Between 2009 and 2010, 446 ears with retraction pocket cholesteatoma underwent primary surgery at 6 institutions in Japan. The extent of cholesteatoma was surgically confirmed, and classified into three stages. RESULTS: The cholesteatoma affected the pars flaccida in 325 ears (73%), the pars tensa in 100 ears (22%), and both regions combined in 21 ears (5%). The hearing outcome (postoperative air-bone gaps dB) worsened as follows (Stage I, II, III): 84%, 68%, 53% in pars flaccida; 71%, 62%, 30% in pars tensa, and 42% at Stage II, and 50% at Stage III in the combined group. The incidence of residual cholesteatoma increased as follows (Stage I, II, III): 2%, 12%, 23% in pars flaccida; 7%, 30%, 21% in the pars tensa group. The severity of disease was reflected in postoperative hearing and increasing incidence of recurrence rate. CONCLUSION: The 2010 JOS staging system is suitable for evaluating initial pathology. It is particularly practical for standardizing reporting of retraction pocket cholesteatoma and for adjusting for the severity of the condition during outcome evaluations. It may also provide information that is useful for counseling patients.