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  5. Cholesteatoma definition and classification
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You are invited to participate in the survey on cholesteatoma definition and classification. In this survey, scientific authorities will be asked to answer some questions about cholesteatoma. It will take approximately a few minutes to complete the questionnaire.
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Please rate the statement on a scale from 0 - 100 (with 0 = strongly disagree; 100 = strongly agree)
Precholesteatoma, early form of cholesteatoma that is defined by the non-self-cleaning retraction pocket with keratin accumulation inside the pocket with absence of invasion of cholesteatoma cells into the tympanic cavity is "cholesteatoma in situ"
0
 
 
 
The best definition for precholesteatoma is:
 
condition with disturbed migration of the surface epithelial cells and self-cleaning property in retraction pocket leading to accumulation of keratin within retraction pocket [Cartilage Tympanoplasty: Classification of Methods. Mirko Tos. 2009]
 
the retraction of Sharpnell membrane responded with disturbed epithelium migration, accumulation of debris, crust formation, infection behind the crust and proliferation of epithelium keratinization [Advanced therapy of otitis media, Cuneyt Alper MD et al. 2003]
 
retraction pockets that accumulate keratin debris [Evidence-Based Otitis Media, Richard M. Rosenfeld,Charles D. Bluestone. 2003]
 
early form of cholesteatoma that is defined by the absence of invasion of cholesteatoma cells into the tympanic cavity, usually before penetration through the tympanic membrane revealing as the presence of a non-self-cleaning retraction pocket with keratin accumulation inside the pocket
 
Other
 
 
 
 
The best definition for cholesteatoma is:
 
Cholesteatoma is a non-neoplastic but destructive lesion containing layers of keratin in a cavity lined by squamous epithelium and subepithelial connective tissue. [Laryngol Otol. 2007 Nov;121(11):1013-9]
 
Cholesteatoma is an aggressive form of chronic otitis media requiring surgical therapy usually defined by the development of a malpighian epithelium within the middle ear and/or mastoid cavities [Eur Ann Otorhinolaryngol Head Neck Dis. 2012 Jun;129(3):148-52]
 
Cholesteatoma is a three-dimensional epidermoid structure exhibiting independent growth, replacing middle ear mucosa, resorbing underlying bone and tending to recur after removal [Otolaryngol Head Neck Surg. 1997 Jun;116(6 Pt 1):678-9.]
 
Cholesteatoma is a cystic lesion surrounding by inflammatory reaction leads to complications by destruction of the adjacent structures.
 
Cholesteatoma is a cystic lesion, the matrix of which is composed of keratin-producing stratified squamous epithelium that rests on a stroma, the perimatrix
 
Cholesteatoma is a benign, but destructive middle ear tumor characterized by a hyperproliferative epithelium with progressive accumulation of keratin.
 
Other
 
 
 
How useful do you think the classification based on otoscopic evaluation of cholesteatoma
1. Attic
2. Pars tensa I (marginal disease)
3. Pars tensa II (central disease)
Not at all useful Not very useful Somewhat useful Very useful
Clinical usefulness
Usefulness in research
 
 
How useful do you think the classification based on based on location and possibility of diagnosis based on location of cholesteatoma and possibility of diagnosis based on otoscopy
I. Petrous Bone Cholesteatoma
II. Middle Ear Cholesteatoma
Not at all useful Not very useful Somewhat useful Very useful
Clinical usefulness
Usefulness in research
 
 
How useful do you think the classification based on clinico-radiological evaluation of tympano-mastoid cholesteatoma?
(A New Staging System for Tympano-mastoid Cholesteatoma. Belal, A; Reda, M; Mehana, A; Belal, Y Journal of International Advanced Otology, 2012, Vol. 8 Issue 1, p63-68)

(T) Tympanic cavity involvement:
TO: No tympanic cavity involvement
Trp: Retraction pocket (precholesteatoma)
T1: cholesteatoma involving one side of one region
Tía: one side of epitympanum
Tib: one side of mesotympanum
T2: cholesteatoma involving both sides of one region
Tía: both sides of epitympanum
T1b: both sides of mesotympanum
T3: Cholesteatoma extending from one region of the middle ear to another (vertical spread)
T4: Holotympanic cholesteatoma filling the whole middle ear
Regions (epity- or meso-, and hypotympanum)
Sides (anterior or posterior in relation to a line along handle of malleus)
(M) Mastoid cavity involvement:
MO: No mastoid cavity involvement
MI : Cholesteatoma extending to the mastoid antrum only
M2: Cholesteatoma extending to mastoid cavity
(C) Presence of complications:
CO: uncomplicated Cholesteatoma
C1 : cranial or extracranial complication
C2: intracranial complications

Interpretation:
Stage 1 (Trp-1M0C0)
Stage 2 (T2 MOCO)
Stage 3 (T3 MO CO; Trp-3 Ml CO)
Stage 4 (T4 MO CO, Any T M2 CO, Any T Any M CI)
Stage 5 (Any T Any M C2)
Not at all useful Not very useful Somewhat useful Very useful
Clinical usefulness
Usefulness in research