title: Using surgical observations of ossicular erosion patterns to characterize cholesteatoma growth.
abstract: OBJECTIVE
  To describe and quantify growth patterns of cholesteatomas within the middle ear using a scaled rating system that characterizes patterns of ossicular erosion.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Patients undergoing first-time surgery for primary and secondary acquired cholesteatomas.
  
  
  METHODS
  Intraoperative assessments of ossicular destruction by cholesteatoma growth were performed.
  
  
  METHODS
  A scaled system was created to classify the degree of erosion for each ossicle. Ossicular destruction patterns were quantified and compared.
  
  
  RESULTS
  A total of 157 ears of 152 patients with cholesteatomas, who met our inclusion criteria, were operated on by the senior author (S.H.S.) between 1992 and 2009. The incus was the most significantly affected ossicle, whereas the stapes was the most variably affected ossicle. The most commonly represented ossicular erosion patterns for primary acquired cholesteatomas demonstrated an intact malleus abutting cholesteatoma, erosion of the incus, and minimal stapes involvement, whereas the common erosion patterns for secondary acquired cholesteatomas demonstrated intact malleus abutting cholesteatoma, erosion of the incus, and erosion of the stapes.
  
  
  CONCLUSIONS
  Previous assessments of ossicular destruction by cholesteatomas were largely created for staging purposes and for guiding surgical reconstruction. Minimal information can be obtained from these data that both describe and quantify cholesteatoma growth patterns. Our ossicle categories more completely described how erosion develops using a scaled system. Common erosion patterns for both primary acquired and secondary acquired cholesteatomas validate anatomic studies and observations of how middle ear anatomy and compartment boundaries guide cholesteatoma growth.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, NY 10021, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Maresh
authors.forename: Olga F
authors.initials: OF
authors.lastname: Martins
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Victor
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Selesnick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000473:pathology* / Q000601:surgery; D004429:Ear Ossicles / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index