Different systems for classification of middle ear cholesteatoma

Abstract

A cholesteatoma consists of an accumulation of desquamated keratin epithelium in the middle ear cleft or any other pneumatized portion of the temporal bone. The envelope of a cholesteatoma is termed matrix, and desquamated keratin is shed continually by the matrix and forms the central mass of the cholesteatoma, similar to the layers of an onion. Cholesteatomas are classified by different systems of classification.

Sade´ in 1976 classified posterosuperior retraction pockets in fourstages according to degree of retraction of tympanic membrane. This staging system is helpful but does not include the duration, presence, or absence of adhesive changes—which relates to reversibility—or other sites.

Tosclassification for pars flaccida retractions composed of 4 stages depend on contact with malleus with or without outer attic wall erosion and degree of its severity.

In 1999, Saleh and Mills, proposed another classification depending on the extent of the lesion, ossicular condition and preoperative complication.

In 2011 Black and Gutteridge classified cholesteatoma into four stages according to degree of tympanic membrane collapse, presence or absence of hearing loss and presence of necrosis. It proposed the surgical procedure needed for each stage.