Cholesteatoma staging

Manuscripts reporting results of surgery for chronic otitis media would be more meaningful if standardized nomenclature were used in describing the type of surgery performed and if standardized classifications were used for the disease process. Standardized nomenclature for surgery type and classifications for chronic otitis media exist. A classification for cholesteatoma, based on pathophysiology, location, eustachian tube function, ossicular defects, and presence or absence of complications is proposed. Congenital cholesteatoma is that which has its nidus of trapped squamous epithelium present at birth. Primary acquired cholesteatoma is associated with a defect in the pars flaccido, while secondary acquired cholesteatoma is associated with a defect in the pars tensa. Tertiary acquired cholesteatoma is defined as that which occurs behind a normal appearing tympanic membrane as the result of implantation or an antecedent middle ear inflammation.