Nationwide Survey of middle ear cholesteatoma surgical cases in Japan

<p>In 2004, the Japan Otological Society (JOS) Committee on Nomenclature started work on creating a cholesteatoma staging system that would be as simple as possible for widespread use in Japanese clinical practice. After initial proposal of the principal staging system for attic cholesteatoma in 2008, we proposed a 2010 version of the staging system for two main types of acquired cholesteatoma: pars flaccida type and pars tensa type. In 2015, we proposed a new version of the staging system for pars flaccida cholesteatoma, pars tensa cholesteatoma, cholesteatoma secondary to a chronic tensa perforation, and congenital cholesteatoma.</p><p>In 2015, the JOS Committee conducted a nationwide survey to promote the use of this system among JOS members and to capture the prevalence of cholesteatoma types and stages. The Committee also gathered information on the surgical methods employed in each case to reveal the current trends in cholesteatoma surgery in Japan.</p><p>In total, 1791 cases from 74 hospitals were registered. These included 1,133 cases of pars flaccida cholesteatoma, 233 cases of pars tensa cholesteatoma, 100 cases of cholesteatoma secondary to a chronic tensa perforation, 234 cases of congenital cholesteatoma, and 91 cases of unclassifiable cholesteatoma.</p><p>Among surgical procedures, canal-wall-down tympanoplasty with canal wall reconstruction is the most widely used procedure (657 cases, 36. 7%). This was followed by 498 cases involving canal-wall-up tympanoplasty (27. 8%), 453 cases involving tympanoplasty without mastoidectomy (25. 3%), and 183 cases involving canal-wall-down without canal wall reconstruction (10. 2%).</p><p>We now have a good understanding of the current trends in cholesteatoma surgery in Japan. We are convinced that it is important to conduct further multicenter studies to clarify the pathogenesis of cholesteatoma. We are confident that information gathered in the next nationwide survey –such as postoperative recurrence rates and postoperative hearing results, as defined by the JOS Staging and Classification System– will lead to the development of improved treatment protocols.</p>