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Original Investigation |

Classification of Cholesteatoma According to Growth Patterns

Leticia Schmidt Rosito, PhD1; Luciana Fick Silveira Netto, MD2; Adriane Ribeiro Teixeira, PhD3; Sady Selaimen da Costa, PhD3
[+] Author Affiliations
1Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
2Department of Audiology, System Health Mãe de Deus, Porto Alegre, Brazil
3Service of Audiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
JAMA Otolaryngol Head Neck Surg. 2016;142(2):168-172. doi:10.1001/jamaoto.2015.3148.
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Importance  Several classifications of cholesteatoma exist, but there are controversies about their clinical application.

Objective  To classify cholesteatomas and describe the prevalence of the subtypes.

Design, Setting, and Participants  A cross-sectional comparative study of 414 ears in 356 consecutive patients with middle ear cholesteatoma and no history of ear surgery treated at a tertiary hospital was conducted from March 8, 2000, to March 30, 2015. Data analysis was conducted from March 30, 2014, to March 30, 2015.

Intervention  Otoendoscopy was conducted, and findings for both ears were recorded.

Main Outcomes and Measures  Cholesteatoma growth patterns were classified as anterior epitympanic, posterior epitympanic, posterior mesotympanic, 2 routes (both the pars flaccida and the pars tensa are involved), and undetermined.

Results  Among the 356 patients in this study, mean (SD) patient age was 33.23 (19.81) years (range, 4-82 years), and 125 patients (35.1%) were female. The right ear was identified as the affected ear in 220 patients (61.8%). A total of 272 (65.7%) ears were from adults. Of the 414 ears that underwent otoendoscopy, posterior epitympanic (142 [34.3%]) and posterior mesotympanic (140 [33.8%]) were the most frequent types of cholesteatoma observed, followed by undetermined (67 [16.2%]) and 2 routes (57 [13.8%]). Anterior epitympanic type was the least frequent (8 [1.9%]). Posterior epitympanic cholesteatoma was more prevalent in adults (111 [40.8%]), whereas posterior mesotympanic cholesteatoma was more frequent in children (43.0%) (P < .001). Anterior epitympanic cholesteatoma was observed only in children.

Conclusions and Relevance  Classifying cholesteatomas according to the growth pattern (anterior epitympanic, posterior epitympanic, posterior mesotympanic, 2 routes, and undetermined) includes all existing types of cholesteatomas of the middle ear. In general, the prevalence of posterior epitympanic and posterior mesotympanic cholesteatoma were similar. Whereas anterior epitympanic and posterior mesotympanic cholesteatomas were more prevalent in children, posterior epitympanic cholesteatoma was more frequent in adults.

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Figure 1.
Cholesteatoma Growth Pattern

A, Posterior epitympanic cholesteatoma is confined to the pars flaccida. B, Posterior mesotympanic cholesteatoma arises in the posterosuperior quadrant of the pars tensa. C, Anterior epitympanic cholesteatoma originates cranially and anteriorly to the malleus head. D, 2 Routes cholesteatoma (the pars flaccida and the pars tensa were both involved).

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Figure 2.
Prevalence of Cholesteatoma Growth Patterns Among the Study Population

Posterior epitympanic and posterior mesotympanic were the most frequent cholesteatomas observed, followed by undetermined and 2 routes. Anterior epitympanic type was the least frequent.

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Figure 3.
Prevalence of Cholesteatoma Growth Patterns in Children and Adults

Posterior epitympanic cholesteatoma was more prevalent in adults, whereas anterior epitympanic and posterior mesotympanic cholesteatomas were more prevalent in children.

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