Learning Objectives:

Objective: To analyze the practicality of staging criteria of acquired cholesteatoma (2010) for standardizing pathological condition in Japan.

Design: A multicenter, retrospective study.

Setting: Six academic tertiary referral centers.

Participants: A total of 446 patients that underwent surgery (for the first time) for acquired retraction pocket cholesteatoma between 2009 and 2010 at 6 institutions in Japan.

Intervention: Cases were managed by trans canal atticotomy (TCA, 42 cases), canal wall down and reconstruction (CWDR, 142 cases), canal wall down (CWD, 29 cases), or canal wall up technique (CWU, 233 cases).

Main Outcome Measures: The extent of cholesteatoma was surgically confirmed, and auditory outcomes and disease recurrence during 3 years after the last operation were assessed.

Results: The cholesteatoma affected the pars flaccida in 325 cases (73%), the pars tensa in 100 cases (22%), and both of these regions in 21cases (5%). The frequency of postoperative air-bone gaps of < 20 dB was 70% in the pars flaccida group, 54% in the pars tensa group, and 43% in the combined group. These rates decreased as the cholesteatoma stage increased. The frequency of residual disease at the “second look” (10%) peaked at 12 postoperative months, whereas it peaked at 24~36 postoperative months after single-stage procedures (4%). Recurrent sac formation exhibited a similar frequency (4%) from 6 months to 36 months. The frequencies of all types of recurrence increased with the disease stage.

Conclusion: Disease stage was found to be related to hearing outcomes and the recurrence rate. This simple staging system may be particularly useful for standardizing the reporting of acquired cholesteatoma and for adjusting for the severity of the condition during outcome evaluations. It might also provide information that is useful for counseling patients.