The authors declare no conflict of interest. A new feature of this study is the statistical evaluation and demonstration of the influence of cholesteatoma location according to STAM classification on the changes of bone conduction after surgery. Similarly, changes of bone conduction were seen in patients who have cholesteatoma in the attic (A), and in the supratubal recess (S1), versus those who had no cholesteatoma in those locations. This theory is supported by the finding that undamaged mucosa of the mastoid cavity is one of the good prognostic factors for post-surgical hearing. In the presented cohort, changes of bone conduction after cholesteatoma surgery were compared, and a significant shift of bone conduction was found in patients with chronic inflammation with cholesteatoma in the mastoid cavity (M) if cholesteatoma is localized in the mastoid cavity, there is a greater probability of bone conduction threshold shift after surgery. reported the influence of cholesteatoma size on deterioration of bone conduction in a cohort of patients with cholesteatoma, but did not find any relationship between cholesteatoma location and the degree of deterioration of bone conduction. This observation contrasts with the general assertion that a pre-surgical decrease in bone conduction is significantly connected with a decrease in bone conduction after surgery. Our observations overall logically infer that pre-surgically deteriorated bone conduction shows a greater tendency towards improvement than pre-surgically unchanged bone conduction. An important positive factor is removal of granulations from the tympanic cavity, and precise preservation of the mucosa in the middle-ear cavity, whereas a negative factor for the threshold of bone conduction proved to be the scars in the round window. Improvement is explained variously by closure of the perilymphatic fistula, unblocking of the membrane of the round window, or removal of cholesteatoma and limitation of action of its toxins. Smaller improvements in bone conduction after chronic otitis media surgery are more common, and in the present cohort, improvement of bone conduction by more than 5 dB was seen in 26 patients (31 ears) (29.5%), and by more than 10 dB in 5 (4.7%) patients, which is in harmony with the literature. Improvement of the threshold of bone conduction by more than 10 dB, occurring in 2–5% patients, is less often reported. Ī transitory decrease in bone conduction in the contralateral ear due to the transfer of the noise of the drill through the cranial bones was also documented. Nevertheless, improvement of the hearing threshold of bone conduction may sporadically even occur. Significant differences were found in the sensorineural hearing loss frequencies at the different cholesteatoma locations. Despite all medical efforts, the hearing threshold of bone conduction continues to deteriorate in some cases. Even though the fact that cholesteatoma affects bone conduction is not new, authors are trying to support this information by hard data and statistical analysis. The precise removal of cholesteatoma and maximal preservation of the bone conduction hearing threshold are the primary goals of surgery. Serious sensorineural hearing loss can be associated with cochlear fistula. Changes in bone conduction are usually explained in two ways: chemically by the effect of released toxins into the inner ear perilymph, which impairs the movement and metabolism of inner ear hair cells and mechanically, by an oval and round window membrane blockade. Most patients with chronic otitis media with cholesteatoma develop a decrease in hearing threshold for both air and bone conductions. This report evaluates newly originated cholesteatoma STAM, EAONO/JOS, and SAMEO-ATO classifications in relation to post-surgically changed bone conduction. Every change in cholesteatoma classification is a challenge for re-examination of complications, hearing gains, or surgical procedures. Classification based on the size of cholesteatoma, condition of the ossicles, and the presence of complications aimed to set up an ascending scale which would correspond to clinical importance.
Due to its locally destructive potential, classifications similar to those of tumor processes have even been proposed. Although chronic otitis media with cholesteatoma has been known for centuries, its terminology and classification have been developing over time.
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