Intraoperative Classification of Cholesteatoma Using ChOLE Classification and Evaluating its Treatment Outcomes Using Inside Out Approach Mastoidectomy

The primary objective is to classify acquired cholesteatoma according to the ChOLE classification system based on the preoperative and intraoperative findings, and to describe prevalence of each stage. The secondary objective is to correlate the extent of inside out approach mastoidectomy required with the staged extent of cholesteatoma. A non-randomized Prospective Observational study conducted in 67 patients in a tertiary care hospital. Each case was categorized according to the ChOLE classification system including cholesteatoma extension, ossicular chain status, life threatening complications and eustachian tube dysfunction. Based on the extent of disease, inside out approach mastoidectomy was done and results analysed. Most patients presented with stage 2 disease [67%]. Canal wall was preserved for all stage I, and in stage II cholesteatoma canal wall was either kept intact, reconstructed or lowered based on the extent of erosion of posterior meatal wall and cholesteatoma extension. All stage III underwent canal wall down mastoidectomy. Staging of cholesteatoma by ChOLE classification allows standardization in reporting gravity of disease and surgical outcomes. Inside out approach mastoidectomy contributes to the successful surgical management of cholesteatoma by eradicating the disease with the creation of a smaller cavity.