ChOLE-Based Stratification of Cholesteatoma Surgery: Predictive Value for Recurrence and Hearing Recovery Article Swipe
Yusuf Arslanhan
,
İsmail Aytaç
,
Elif Baysal
,
Orhan Tunç
,
Berkay Güzel
,
E Ciftel
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.3390/biomedicines13082040
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.3390/biomedicines13082040
Objectives: This study aimed to evaluate the clinical and hearing outcomes of patients with cholesteatomatous chronic otitis media using the ChOLE classification system and to assess its utility in predicting recurrence, guiding surgical approach, and anticipating hearing recovery. Materials and Methods: This retrospective study included 130 patients (141 ears) who underwent surgery for cholesteatoma between 2011 and 2020. Data were collected from surgical notes, imaging studies, and audiological evaluations. Patients were classified according to the ChOLE criteria, which incorporate cholesteatoma extension (Ch), ossicular chain status (O), and life-threatening complications (L). Surgical procedures and functional outcomes were compared across different stages and classification groups. Hearing outcomes were assessed in the early (3rd month) and late (2nd year) postoperative period. Results: Among the 130 patients (141 ears) evaluated, Stage II was the most common ChOLE stage (74.4%), followed by Stage I (17.7%) and Stage III (7.8%). The most frequently observed cholesteatoma extent was Ch3. A statistically significant association was found between surgical technique and ChOLE stage (p = 0.001): canal wall-down (CWD) tympanomastoidectomy was performed in 91% of Stage III cases and 84% of Stage II cases, whereas 76% of Stage I cases underwent canal wall-up (CWU) procedures. The overall recurrence rate was 29.5% in the CWU group and 16.4% in the CWD group, although this difference did not reach statistical significance (p = 0.792). However, ossicular chain status (O) showed a strong association with both early and late hearing outcomes. At 2 years, conductive hearing success was achieved in 90.9% of O0 patients, compared to 14% of O3b and 0% of O4 patients (p = 0.001). With regard to cholesteatoma extent (Ch), a statistically significant correlation was observed with early air–bone gap (ABG) closure success (p = 0.008) and late air conduction thresholds (p = 0.015). Similarly, ChOLE stage was significantly associated with early conductive hearing success (p = 0.012) and late ABG closure (p = 0.015). Overall, long-term hearing outcomes were superior to early results. Hearing success increased from 19.1% to 24.8% for air conduction thresholds and from 23% to 31.2% for hearing gain when comparing early and late follow-up periods. Conclusions: The ChOLE classification proved useful in guiding surgical strategy and predicting functional outcomes in cholesteatoma surgery. Advanced stage and greater cholesteatoma extension were associated with more extensive surgical procedures and poorer hearing results. Long-term audiological follow-up provided more accurate insights into surgical success. The standardized ChOLE system facilitates consistent reporting and meaningful comparison across institutions and studies.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.3390/biomedicines13082040
- https://www.mdpi.com/2227-9059/13/8/2040/pdf?version=1755780809
- OA Status
- gold
- References
- 31
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4413375907
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4413375907Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.3390/biomedicines13082040Digital Object Identifier
- Title
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ChOLE-Based Stratification of Cholesteatoma Surgery: Predictive Value for Recurrence and Hearing RecoveryWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2025Year of publication
- Publication date
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2025-08-21Full publication date if available
- Authors
-
Yusuf Arslanhan, İsmail Aytaç, Elif Baysal, Orhan Tunç, Berkay Güzel, E CiftelList of authors in order
- Landing page
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https://doi.org/10.3390/biomedicines13082040Publisher landing page
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https://www.mdpi.com/2227-9059/13/8/2040/pdf?version=1755780809Direct link to full text PDF
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YesWhether a free full text is available
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goldOpen access status per OpenAlex
- OA URL
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https://www.mdpi.com/2227-9059/13/8/2040/pdf?version=1755780809Direct OA link when available
- Concepts
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Cholesteatoma, Medicine, Stage (stratigraphy), Surgery, Retrospective cohort study, Mastoidectomy, Tympanoplasty, Paleontology, BiologyTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
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31Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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