Cholesteatoma Definition and Classification: A Literature Review

Abstract

Review INTRODUCTIONThe management of cholesteatoma continues to be a challenge for otolaryngologists around the world. Even in countries with advanced healthcare facilities, undertaking routine physical examinations, with good access to specialists, and where efforts are taken for the prevention, early detection, and treatment of cholesteatoma, there is a considerable prevalence of cholesteatoma and its complications in children and adults.Diagnosis of cholesteatoma is performed by otolaryngologists using different methods, including obtaining the history that is characteristic for cholesteatoma suspicion, searching for or evidence of cholesteatoma during the physical examination using otoscopy and/or otomicroscopy, and interpretation of imaging (computed tomography and/or magnetic resonance) [1].Despite the fact that cholesteatoma is diagnosed throughout the world, there are differences in the definition, classification, and management of cholesteatoma. These differences make it difficult to compare the reports in the literature, and limit the ability to derive further conclusions from individual or regional outcomes. Therefore, it is essential to create a common scientific language, with the definitions of an issue as a principle. Furthermore, utilizing a comparable classification system will allow investigators to share their experience across the world, leading to better assessment and management of cholesteatoma.To achieve this, a recent initiative aimed to explore opinions among the members of European Academy of Otology & Neuro-otology (EAONO) regarding the definition and classification of cholesteatoma. Although consensus was achieved on the cholesteatoma definitions, it could not be achieved on its classification [2] . The process of development of the questionnaires, the responses obtained from the EAONO members through three cycles of questionnaires, and the final set of statements were reported in detail. Here we report the literature review that led to the development of the questionnaire on the definitions and classification to provide a basis for the outcome. In addition, we present various classifications of cholesteatoma in the literature and emphasize the strengths and weaknesses of each of these classifications to stimulate an effort to develop a consensus on the classification as well. METHODSEAONO steering group decided to undertake the task of developing guidelines in the field of otology and neurotology. Guidelines regarding the assessment and management of cholesteatoma were established as a priority. Among the committees established, the task of developing the guidelines for the definition and classification of cholesteatoma was assigned to Ewa Olszewska in June Cholesteatoma Definition and Classification: A Literature ReviewCholesteatoma is a serious otolaryngologic condition that to date remains an important problem and poses a challenge to otolaryngologists around the world. To improve the approach pertaining to the diagnosis and management of middle ear cholesteatoma, clear, clinical...

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“…Many attempts have been made to categorize the ventilation properties of the mastoid (11,12). Initially we distinguished five different categories, however the interobserver reliability was poor.…”

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“…Congenital cholesteatoma is a congenital displacement of squamous epithelium during the embryonal phase, while acquired cholesteatoma describes invasion of keratinizing squamous epithelium from the external auditory canal or the tympanic membrane into the middle ear after birth. Despite being a common otologic diagnosis, there are still large differences in the definition, classifications and management of cholesteatomas [3]. Yet, standardized reporting of cholesteatoma characteristics and surgical outcomes is a prerequisite for comparison of surgical techniques and outcomes among centers in an international setting.…”

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