Per Operative Extent of Disease in Chronic Suppurative Otitis Media (CSOM) Squamosal Type and Ossicular Chain Status based on“ChOLE”and “EAONO/JOS”Classification.

Ihsanullah ,, Sharafat Ali Khan, Sohail Khan, Naveed Khan, Inayatullah ,, Muhammad Usman


Background: Otitis media is infection of middle ear, with tympanic membrane perforation the term huge or massive is used when it
has extension. Similarly, if there is bone erosion, then it is considered to be of severe type. The draw back in this scenario is that
comparison for outcome cannot be carried out and hence objective learning is not possible due to absence of uniform classification.
The European Academy of Otology and Neurotology and the Japanese Otological Society has recently introduced a classification
system grounded on cholesteatoma extension and its complications and similarly another is ChOLE-classification. In this study
both staging system have been used primarily for extension of disease and ossicular chain status.
Objective: To evaluate the intraoperative extent of disease and to analyze the nature of ossicular erosion in patients of squamosal
type of CSOM based on ChOLE and EAONO/JOS Classification.
Material and Methods: This Retrospective chart review study was conducted from January 2017 to June 2019 in ENT
Department, Saidu Group of Teaching Hospitals, Saidu Sharif Swat, Khyber Pakhtunkhwa, Pakistan. A total of 95 patients of
squamosal type of Chronic Supportive Otitis Media operated during the period were included in the study after following the set
exclusion criteria. Peroperative extent of disease was noted from the patient's charts and operation notes according to the
“EAONO/JOS” classification system for cholestetoma staging. The ossicular status at the end of surgery was also noted from the
operation notes according to the “ChOLE” classification. The data collected was analyzed for results.
Results: Majority of the patients (80%) were in stage 3, followed by stage 2 (9%) and stage 4 (8%). Three percent of the patients
were in stage 1. Class “O” was 3%, in which the ossicular chain was intact while Class 1 was 18% and Class 2 was 34%. Majority of
the patients (45%) were in advanced stage of Class 3, in which either mobile stapes (3a) or Mobile foot plate (3b) was observed.
Conclusion: Multi ossicular involvement was more common likely contributing to difficulty in ossicular reconstruction and hearing
restoration. Moreover both the staging systems are quite helpful in surgically oriented categorization of extent of disease.


Squamosal Chronic Supporative Otitis Media, Ossicular status, Extent of Cholesteatoma. Conflicting interest: The authors declare no conflict of interest.

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