International Collaborative Assessment of the Validity of the EAONO-JOS Cholesteatoma Staging System

Abstract

Objective: Assessment of validity of the Japanese Otological Society and the European Academy of Otology and Neurotology (EAONO–JOS) cholesteatoma staging system (EJS) through international collaboration to investigate: (a) feasibility of retrospectively staging previously acquired data, (b) strengths and weaknesses of the staging system. Method: Nine centers with prospective cholesteatoma databases were recruited. Cases were allocated to EJS Stage at each center using details from time of initial surgery. An independent rater also staged the cases and noted any discrepancies. At one center results from database staging were compared with staging based on contemporaneous operative records. Inter and intrarater reliabilities were calculated, and recidivism rates calculated according to Stage. Results: Of 1482 cases of cholesteatoma, 320 (22%) were Stage 1, 977 (67%) Stage 2, 153 (11%) Stage 3 and 4 (0.3%) Stage 4. No database contained details of all parameters required for accurate staging. Staging discrepancies occurred in >10% cases but inter and intrarater reliability of staging were high (Kappa 0.8; 95% confidence interval between 0.7–0.9). At 5 years, 11% had residual and 8% had recurrent cholesteatoma: rates increased with Stage but generally not significantly (Kaplan–Meier Log Rank analysis). Conclusion: The EJS Staging system provides an internationally agreed standard for collecting data to classify cholesteatoma severity. Although data can be applied retrospectively with reasonable reliability, prospective data collection would prevent inaccuracies that arise from missing data fields. To enhance validity of the EJS system, we propose clearer definitions of some categories. Refinements to definitions of stage may improve prognostic utility of the EJS but should be made using evidence powered by large-scale collaboration.

Correlation between peri-operative complication in middle ear cholesteatoma surgery using STAMCO, ChOLE, and SAMEO-ATO classifications

“…Overall complication rate was 17% (95% CI 11–24). This finding was comparable to that published in the literature up to now [ 6 ]. The most common complication was lateral semi-circular canal fistula (LSC fistula) with a frequency of 41% among complicated surgery and an overall frequency of 7.6%.…”

“…Many classifications for cholesteatomas and tympanomastoid surgery have been proposed with the aim of describe the severity of the cholesteatoma and the risk of recurrence and to compare surgical outcomes and surgical procedures [1][2][3][4]. The most recently proposed middle ear cholesteatoma classifications are STAMCO, ChOLE, and SAMEO-ATO classifications [2][3][4][5][6]. The presence of pre-or intra-operative complications is a variable considered both in STAMCO and ChOLE classifications.…”

A Retrospective Analysis and Comparison of the STAM and STAMCO Classification and EAONO/JOS Cholesteatoma Staging System in Predicting Surgical Treatment Outcomes of Middle Ear Cholesteatoma

“…In all analyses, the cholesteatoma stage was not associated with residual cholesteatoma. The prognostic value of the EJS for predicting residual or recurrent cholesteatoma was recently studied by James et al (15). In their study, the rate of recurrent cholesteatoma was significantly lower for stage 1 compared to stage 4 (intracranial complications), with no significant difference in recurrent cholesteatoma with other stages.…”

Practical applicability of the STAMCO and ChOLE classification in cholesteatoma care

“…They state that the validity of the staging system is determined by how complete the necessary information needed was recorded. And a lack of clear correlation between the stage and risk of recurrent cholesteatoma is still a limitation [ 28 ]. Thus, before staging, it is important to gain more experience in using the classification and a longer period of registration.…”