Arslanhan Yusuf, Aytac Ismail, Baysal Elif, Tunc Orhan, Guzel Berkay, Ciftel Erhan
Department of Otorhinolaryngology, Viransehir State Hospital, 63700 Şanlıurfa, Turkey.
Department of Otorhinolaryngology, School of Medicine, Gaziantep University, 27310 Gaziantep, Turkey.
Biomedicines. 2025 Aug 21;13(8):2040. doi: 10.3390/biomedicines13082040.
This study aimed to evaluate the clinical and hearing outcomes of patients with cholesteatomatous chronic otitis media using the ChOLE classification system and to assess its utility in predicting recurrence, guiding surgical approach, and anticipating hearing recovery. This retrospective study included 130 patients (141 ears) who underwent surgery for cholesteatoma between 2011 and 2020. Data were collected from surgical notes, imaging studies, and audiological evaluations. Patients were classified according to the ChOLE criteria, which incorporate cholesteatoma extension (Ch), ossicular chain status (O), and life-threatening complications (L). Surgical procedures and functional outcomes were compared across different stages and classification groups. Hearing outcomes were assessed in the early (3rd month) and late (2nd year) postoperative period. Among the 130 patients (141 ears) evaluated, Stage II was the most common ChOLE stage (74.4%), followed by Stage I (17.7%) and Stage III (7.8%). The most frequently observed cholesteatoma extent was Ch3. A statistically significant association was found between surgical technique and ChOLE stage ( = 0.001): canal wall-down (CWD) tympanomastoidectomy was performed in 91% of Stage III cases and 84% of Stage II cases, whereas 76% of Stage I cases underwent canal wall-up (CWU) procedures. The overall recurrence rate was 29.5% in the CWU group and 16.4% in the CWD group, although this difference did not reach statistical significance ( = 0.792). However, ossicular chain status (O) showed a strong association with both early and late hearing outcomes. At 2 years, conductive hearing success was achieved in 90.9% of O0 patients, compared to 14% of O3b and 0% of O4 patients ( = 0.001). With regard to cholesteatoma extent (Ch), a statistically significant correlation was observed with early air-bone gap (ABG) closure success ( = 0.008) and late air conduction thresholds ( = 0.015). Similarly, ChOLE stage was significantly associated with early conductive hearing success ( = 0.012) and late ABG closure ( = 0.015). Overall, long-term hearing outcomes were superior to early results. Hearing success increased from 19.1% to 24.8% for air conduction thresholds and from 23% to 31.2% for hearing gain when comparing early and late follow-up periods. The ChOLE classification proved useful in guiding surgical strategy and predicting functional outcomes in cholesteatoma surgery. Advanced stage and greater cholesteatoma extension were associated with more extensive surgical procedures and poorer hearing results. Long-term audiological follow-up provided more accurate insights into surgical success. The standardized ChOLE system facilitates consistent reporting and meaningful comparison across institutions and studies.
本研究旨在使用ChOLE分类系统评估胆脂瘤型慢性中耳炎患者的临床和听力结果，并评估其在预测复发、指导手术方法和预测听力恢复方面的效用。这项回顾性研究纳入了2011年至2020年间接受胆脂瘤手术的130例患者（141耳）。数据收集自手术记录、影像学检查和听力学评估。患者根据ChOLE标准进行分类，该标准包括胆脂瘤扩展情况（Ch）、听骨链状态（O）和危及生命的并发症（L）。比较了不同阶段和分类组的手术程序和功能结果。在术后早期（第3个月）和晚期（第2年）评估听力结果。在评估的130例患者（141耳）中，II期是最常见的ChOLE分期（74.4%），其次是I期（17.7%）和III期（7.8%）。最常观察到的胆脂瘤范围是Ch3。手术技术与ChOLE分期之间存在统计学显著关联（P = 0.001）：91%的III期病例和84%的II期病例进行了开放式乳突根治术，而76%的I期病例接受了完壁式手术。开放式乳突根治术组的总体复发率为29.5%，完壁式手术组为16.4%，尽管这种差异未达到统计学显著性（P = 0.792）。然而，听骨链状态（O）与早期和晚期听力结果均显示出强烈关联。在2年时，O0患者的传导性听力改善成功率为90.9%，而O3b患者为14%，O4患者为0%（P = 0.001）。关于胆脂瘤范围（Ch），观察到与早期气骨导差（ABG）闭合成功率（P = 0.008）和晚期气导阈值（P = 0.015）存在统计学显著相关性。同样，ChOLE分期与早期传导性听力改善成功率（P = 0.012）和晚期ABG闭合（P =
0.015）显著相关。总体而言，长期听力结果优于早期结果。比较早期和晚期随访期时，气导阈值的听力改善成功率从19.1%提高到24.8%，听力增益从23%提高到31.2%。ChOLE分类被证明在指导胆脂瘤手术的手术策略和预测功能结果方面是有用的。晚期和更大的胆脂瘤扩展与更广泛的手术程序和更差的听力结果相关。长期听力学随访为手术成功提供了更准确的见解。标准化的ChOLE系统有助于跨机构和研究进行一致的报告和有意义的比较。
