Abstract
There are many classifications for cholesteatomatous otitis media but none correspond exactly to the formulation of a surgical protocol for the middle ear and mastoid nor are any specific for the extension of the otitis media, making it difficult to interpret the published results. All the available classifications are limited to the cholesteatoma and, moreover, the variety of the reported studies in literature does not allow a standardization to define middle ear pathology and surgical procedures. The aim of this paper is to propose a novel staging system for middle ear diseases paying attention to the involvement of tympanic Cavity (C), Attic (A), and Mastoid (M): the CAM classification.In particular, CAM classification is composed of three symbols (0 / + / ρ) and two letters (t and m, tiny and ivory mastoid cases) related to the alphabetic initial of the macroscopic region, being able to allow a clear and specific description of the local situation. Moreover, the possibility to describe the temporal bone and the potential use of sub-groups to specifically define the involvement of the tympanic cavity and the attic could allow the creation of a common otologic language among all the different centres.
Highlights
BackgroundThe first approaches to the surgical management of middle ear and mastoid diseases date back to the time of the Egyptians
The great variety of surgical approaches available is due to the ear anatomy and its complexity, the small size of mastoid, the complex spatial relations of important structures, and the possible presence of specific otologic diseases characterized by heterogeneous extension with potential damage
There is no standardized staging for the type of surgical procedure and the classification of the extension of the otitis media, making it difficult to interpret the published results
Summary
Two more letters are included: t, to indicate the presence of a conductive hearing loss in a negative CT, and m, tiny, to point out the possible condition of an ivory mastoid The combination of these features allows a fast and easy comprehension of the anatomic structures and the local involvement of cholesteatoma. The aim of this preoperative description of the attic subareas involved by pathology is to define if it should be the eventuality of a surgical ossicular chain dislocation to have a better visualization of the operating field. CAM classification is composed only of these two subclassifications (A + m / C + r ) with the aim to make this system easy and fast to use in the otologic practice
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