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Dear Respondents,
Thank you for your cooperation and participation in the survey so far. You will be asked the last time to complete a revised survey that asks questions concerning definition and classification of cholesteatoma. Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. It is very important for us to learn your opinions and finish this project.Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Prof. Ewa Olszewska by email [email protected]
Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below |
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1. Acquired cholesteatoma is a subcategory of chronic otitis media.
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| 2. Cholesteatoma is a mass formed by the keratinizing squamous epithelium in the middle ear and/or mastoid, subepithelial connective tissue and progressive accumulation keratin debris with/without surrounding inflammatory reaction. |
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3. Acquired cholesteatoma is characterized by clinical symptoms that are the result of growth with/without destruction of the adjacent structures:
- ± tympanic membrane perforation
- ± otorrhea
- ± hearing deterioration
and/or CT/MRI findings (soft tissue masses, focal areas of bony erosion of the middle ear and mastoid). |
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| 4. The term "chronic otitis media with or without cholesteatoma” is proper. |
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| 5. Cholesteatoma consists of: matrix (keratinizing squamous epithelium), perimatrix (varying thickness of subepithelial connective tissue) and keratin debris. |
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| 6. Pathophysiology of cholesteatoma is not completely understood. |
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| 7. Recurrent infections and inflammatory reaction at the subepithelial connective tissue of cholesteatoma contribute to the bone resorption in the adjacent area. |
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| 8. Cholesteatoma is diagnosed by detailed otologic history, physical examination with otoscopy and/or otomicroscopy with or without imaging. |
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| 9. Cholesteatoma is classified into two general categories: congenital and acquired. |
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| 10. Acquired cholesteatoma is associated with either a perforation or a retraction pocket of the tympanic membrane or implantation from trauma or iatrogenic causes. |
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| 11. Acquired cholesteatoma with ear drum perforation develops from extension of keratinizing squamous epithelium of the tympanic membrane or external ear canal into the middle ear and/or mastoid. |
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| 12. Acquired cholesteatoma with retraction pocket originates from the external layer of the tympanic membrane retraction pocket, when the retraction pocket looses its ability of self cleaning and starts accumulation of keratin debris. |
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| 13. Acquired cholesteatoma is not present at birth. |
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| 14. Acquired cholesteatomas may be primary or secondary. |
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| 15. Primary acquired cholesteatoma develops from retraction pocket of pars flaccida, pars tensa or both and is a sequela of the dysfunction of middle ear pressure regulation. |
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| 16. Secondary acquired cholesteatoma may develop secondary to the tympanic membrane perforation as a result of acute or chronic otitis media, ear trauma or may be iatrogenic. |
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| 17. Congenital cholesteatoma is an expanding cystic mass with keratinizing squamous epithelium located medial to intact tympanic membrane, assumed to be present at birth but usually diagnosed during infancy or in early childhood in patients with no prior history of otorrhea, perforation or previous ear surgery. |
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| 18. A history of previous bouts of otitis media or an effusion does not exclude a congenital cholesteatoma. |
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| 19. Congenital cholesteatoma is usually located at the anterosuperior quadrant of the middle ear. However, it may be located at the posterosuperior quadrant or at other intracranial locations. |
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20. The clinical presentation of congenital cholesteatoma is determined by the location and extent of the lesion. It may be characterized by:
-± abnormal otoscopic examination (white mass medial to an intact tympanic membrane)
-± rarely with conductive hearing loss when enlarged to fill the middle ear or erodes the ossicles
-± extremely rarely with pain
and/or CT/MRI findings (usually as a round soft tissue mass at the anterosuperior quadrant, rarely with bony erosion). |
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| 21. Precholesteatoma is a stage of retraction pocket with/without invisible depth, or not completely visible depth, with/without bony erosion, with early signs of loss of self cleaning ability without apparent accumulation of keratin debris. |
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| 22. Cholesteatoma recidivism may be either from residual or recurrent cholesteatoma. |
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| 23. Residual cholesteatoma results from incomplete surgical removal of the epidermal matrix of cholesteatoma. |
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| 24. Recurrent cholesteatoma occurs after complete surgical removal as a result of a new pathological process of the tympanic membrane or the dysfunction of middle ear pressure regulation. |
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| 25. Cholesteatoma recurrence is the redevelopment of cholesteatoma at the same site or in another location after previous surgical removal. It occurs after a period of time in which no cholesteatoma could be detected. |
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26. New classification of cholesteatoma proposed by the authors based on systemic search of evidence:
1. Acquired attic cholesteatoma - retraction or perforation of the pars flaccida or Shrapnell membrane; cholesteatoma extending to the attic, going through the aditus and eventually reaching the antrum, mastoid or tympanic cavity.
2. Acquired tympanic sinus cholesteatoma - retraction or perforation of posterior-superior pars tensa, cholesteatoma extending to the tympanic sinus and posterior portion of the tympanic membrane.
3. Acquired tensa cholesteatoma – retraction, perforation or total adhesion of the pars tensa of tympanic membrane involving the tympanic orifice of the auditory tube
4. Congenital cholesteatoma - cholesteatoma located medial to intact tympanic membrane
5. Recurrent/residual cholesteatoma - redevelopment of cholesteatoma at the same site or in another location after previous surgical removal
is useful in clinical practice. |
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27. New clinical staging system for cholesteatoma proposed by the authors based on systemic search of evidence:
Stage I – middle ear and mastoid cell system involved cholesteatoma without bone erosion
Stage II – cholesteatoma causes temporal bone erosion without following complications : 1.facial palsy 2.Intracranial complication 3.labyrynthine fistule 4.large defect of bony external ear canal 5.profound sensorineural hearing loss 6.total adhesion of the ear drum
Stage III – any cholesteatoma causing at least one of the following complications : 1.facial palsy 2.Intracranial complication 3.labyrynthine fistule 4.large defect of bony external ear canal 5.profound sensorineural hearing loss 6.total adhesion of the ear drum
is useful in clinical practice. |
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