Abstract
PurposeTo evaluate the recently proposed SAMEO-ATO framework for middle ear and mastoid surgery, by correlating it with the functional outcome in a large cohort of patients operated for middle ear and mastoid cholesteatoma in a tertiary referral center.MethodsWe retrospectively included all surgeries for middle ear and mastoid cholesteatoma undergone in our Department between January 2009 and December 2014, by excluding revision surgeries, congenital and petrous bone cholesteatoma. All surgeries were classified according to the SAMEO-ATO framework. The post-operative air bone gap (ABG) was calculated and chosen as benchmark parameter for the correlation analysis.Results282 consecutive surgeries for middle ear and mastoid cholesteatoma were released in the study period on a total of 273 patients, with a mean age of 41.2 years. All patients were followed for an average period of 55.3 months. 54% of patients underwent M2c mastoidectomy (Canal Wall Down, CWD), while the remaining underwent Canal Wall Up (CWU) procedures, being M1b2a mastoidectomy the most common one (33%). Mean pre-operative and post-operative ABGs were 29.2 and 23.5 dB, with a significant improvement (p < 0.0001). ‘Mastoidectomy’ and ‘Ossicular reconstruction’ parameters of SAMEO-ATO showed significant association with postoperative ABG, with smaller residual gaps for the classes Mx and On, and worse hearing results for M3a and Ox.ConclusionOur results show the utility of SAMEO-ATO framework, and in particular of ‘M’ (Mastoidectomy) and ‘O’ (Ossicular reconstruction) parameters, in predicting the hearing outcome.
Highlights
Cholesteatoma is a mass of keratinizing squamous epithelium located in the middle ear and mastoid that requires surgical treatment
Surgical treatment of middle ear and mastoid cholesteatoma has been traditionally classified into Canal Wall Up (CWU) and Canal Wall Down (CWD) tympanoplasty [4, 5]; the advent of some technical refinements, such as mastoid obliteration [6, 7] and endoscopic ear surgery (EES) [8], has increased the number of surgical techniques and the variables that can affect the surgical outcome
The SAMEO-ATO framework has been recently proposed to categorize the surgical techniques used for the treatment
Summary
Cholesteatoma is a mass of keratinizing squamous epithelium located in the middle ear and mastoid that requires surgical treatment. To facilitate the comparison of surgical outcomes and identify prognostic factors, the European Academy of Neurotology and the Japan Otological Society have recently published a joint consensus statement on Surgical treatment of middle ear and mastoid cholesteatoma has been traditionally classified into Canal Wall Up (CWU) and Canal Wall Down (CWD) tympanoplasty [4, 5]; the advent of some technical refinements, such as mastoid obliteration [6, 7] and endoscopic ear surgery (EES) [8], has increased the number of surgical techniques and the variables that can affect the surgical outcome. In 2018, the International Otology Outcome Group (IOOG) proposed a framework that aimed at the categorization of tympano-mastoid surgery [9], with the purpose of favoring the pooling of surgical data in a single large. The SAMEO-ATO framework categorizes both mastoid and middle ear surgery. One of the theoretical advantages of such classification is that it may allow a more precise comparison of surgical outcomes and may help to identify factors that affect the outcome
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