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

OBJECTIVE: To evaluate and compare the STAM classification, STAMCO classification and the EAONO/JOS staging system as predictors for cholesteatoma recidivism and postoperative hearing, using a large patient cohort in our tertiary referral center. METHOD: Two hundred thirty-one patients who underwent surgery for primary cholesteatoma between 2003 and December 2012 were included and retrospectively classified and staged according to the STAM classification, STAMCO classification, and EAONO/JOS staging system. Data on cholesteatoma recidivism rates and postoperative hearing were collected. The predictive value of the three instruments for recurrent and residual cholesteatoma was compared by using receiver operating characteristic curves. RESULTS: For predicting recurrent cholesteatoma, the STAMCO classification was significantly superior compared to the other two instruments. For predicting residual cholesteatoma, the STAMCO classification was superior to the EANO/JOS Staging system. The postoperative hearing shows a significant increase in ABG with increasing extension of cholesteatoma in the CWU group and a significant decrease in AC threshold level with increasing stage and a significant increase in AC with increasing ossicular chain status in the CWD group. CONCLUSION: Based on our study, the STAMCO classification represents the best available predictor for recurrent cholesteatoma and holds most promise for predicting residual cholesteatoma. Extension of cholesteatoma seems to be linked to postoperative hearing and thus the classifications and staging systems may be able to predict postoperative hearing. More studies are needed to assess the validation of these classifications.

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