International Otology Outcome Group and the International Consensus on the Categorization of Tympanomastoid Surgery

Abstract

The International Otology Outcome Group (IOOG) was founded in 2017 to encourage and facilitate international collaboration with regard to the surgical outcome of ear surgery. This report outlines the methodology and recommendations of the consensus-based categorization of tympanomastoid surgery produced by the IOOG. The IOOG Steering Committee used the acronym SAMEO-ATO to categorize tympanomastoid operations, representing the stage of surgery, approach, mastoid bone extirpation, external bony wall repair, obliteration of the mastoid cavity, access to the middle ear, tympanic membrane reconstruction, and ossicular reconstruction. A modified Delphi technique was used to obtain international consensus. The expert panels included the chairpersons from 21 otology societies. The approval rate of the SAMEO-ATO system from the otology societies was 95%. The SAMEO-ATO scheme was presented at the 31st Politizer Meeting for field testing. There were no objections or serious concerns raised. Some international otologists wished to see more surgical categories included to reflect the varieties of surgical techniques, but they accepted that it would make the whole system cumbersome. In addition to providing an international categorization of tympanomastoid surgery, the IOOG Steering Committee plans to introduce a common otology dataset that the international otology community could use to record their surgical outcome. The high level of international consensus on the IOOG categorization of tympanomastoid surgery supports this tool for surgeons to pool their surgical data into a large database for research and comparative audit.

Evaluation of the SAMEO-ATO surgical classification in a Dutch cohort

“…These 34 incomplete surgical reports could be due to the retrospective application of the SAMEO-ATO classification. The IOOG recognizes in the user notes and publication that the SAMEO-ATO is established for prospective use and that retrospective use may be impaired due to incomplete previously collected data [7]. Especially the precise description of the access to middle ear (A) was often not clearly described in the surgical report.…”

“…All surgical reports were analyzed and retrospectively classified according to the SAMEO-ATO classification by two independent ENT researchers (PM, SA), using the SAMEO-ATO framework [7] (https ://www.ioog.net). If it was not possible to classify a specific subgroup of the classification, this was marked with a question mark.…”

Qualität in der Mittelohrchirurgie – eine kritische Standortbestimmung

“…canal wall down, CWD) hinteren Gehörgangswand hat sich über die Jahre durchgesetzt. Zudem wird die neue Klassifikation der Tympanomastoid-Chirurgie hoffentlich noch mehr Schärfe in die Definition von Vorgehen und Ausprägung der chi rurgischen Technik bringen [109].…”

“…Abschließend kommen die Autoren jedoch zu der Empfehlung, dass die CWD-Technik großzügiger angewendet und letzten Endes auch bevorzugt werden sollte. Daraus leitet sich auch die Empfehlung eines mindestens 2-eher 5-jährigen Intervalls zur abschließenden Beurteilung von Cholesteatom-Rezidiven (-Residuen) ab [35,[109][110][111].…”

“…Die jüngste Publikation, stellt die von der eben genannten IOOG, zur Kategorisierung der Tympanomastoid-Chirurgie dar [109]. In einem ähnlichen Verfahren wurde darin ein Konsens zur Beschreibung der Mittelohrchirurgie erarbeitet.…”