Outcomes of Primary Acquired Cholesteatoma Managed with Endoscopic-Microscopic Approaches According to EAONO-JOS and SAMEO-ATO Classifications.

Abstract

Objectives: To assess the utility of the European Academy of Otology and Neurotology-Japanese Otological Society (EAONO-JOS) and SAMEO-ATO tympanomastoid surgery classification systems in predicting recidivistic disease in patients with primary acquired cholesteatoma and to compare outcomes between endoscopic and combined approaches.

Study design: Retrospective chart review.

Setting: Academic teaching hospital.

Methods: Eighty-one surgical ears from 77 patients were operated on between 2015 and 2022 by the senior author and fit the inclusion criteria. Surgeries were retrospectively classified according to SAMEO-ATO and EAONO-JOS classifications. Descriptive statistics for staging and demographics were reported. Multivariate analysis was completed to assess the correlation between EAONO-JOS and SAMEO-ATO classification and residual disease with covariates including age. The incidence of residual and recurrent disease was investigated using Kaplan-Meier survival analysis. Patients had a median follow-up of 36.7 months.

Results: Based on EAONO-JOS staging, 13.6% of ears were stage I, 65.4% were stage II, 21.0% were stage III, and 0% were stage IV. Exclusive endoscopic approaches (A1Mx, A1M2a, and A1M2b) were performed in 50.6% of all ears, and combined approaches (A4M1a, A4M1b, A4M1a + M2a, and A4M2c) in the remaining 49.4% of ears. Overall residual disease rate was 41.9% (n = 34), while recurrence occurred in 7.4% (n = 6). In Kaplan-Meier analysis, SAMEO-ATO and EAONO staging did not predict residual or recurrent disease. In multivariate analysis, age was correlated with a lower risk of residual disease for each advancing year (HR 0.97, 95% CI = 0.95-0.99, p < 0.01). Compared to combined approaches during primary surgery, exclusive endoscopic approaches were correlated with lower conversion to CWU or CWD mastoidectomy for revision surgery (HR 0.19, 95% CI = 0.05-0.71, p = 0.014).

Conclusion: In this cohort of patients with primary acquired cholesteatoma, predominantly EAONO-JOS stage II and III, half were managed with an exclusive transcanal endoscopic approach. Although EAONO-JOS and SAMEO-ATO did not predict recidivism, the classification is an important starting point for maintaining uniformity in collecting outcomes. The study was limited by a small sample size and limited follow-up duration.