title: Multidimensional staging system for pediatric acquired cholesteatoma: A 30-year verification data.
abstract: OBJECTIVE
  This article presents a points-based prognostic prediction model for pediatric acquired cholesteatoma, incorporating the multidimensional factors that contribute to surgical failure.
  
  
  METHODS
  This study included 132 ears with acquired cholesteatoma from 128 children (≤18 years) identified between 1982 and 2012. Each case was scored for the extent of the cholesteatoma, history of grommet insertion, age of the patient, ossicular destruction, and otorrhea. The patients were classified as stage I, II, or III. We compared differences between stages regarding the cumulative rates of recidivism and linear trends in these rates.
  
  
  RESULTS
  Among stage I cases, the rate of cumulative recidivism was 0%; however, among stage 2 cases, this increased with time, eventually leveling off at 15.7% after 18 years of follow-up. The same was observed among stage III cases, which leveled off at 34.1% after 17 years of follow-up. In the second half of the cohort and the entire cohort, differences in the cumulative recidivism curves reached statistical significance, as did the linear trends (all p<0.05).
  
  
  CONCLUSIONS
  Our findings demonstrate the efficacy of the proposed multidimensional staging system in linking the severity of cholesteatoma to outcomes, thereby enabling the stratification of patients according to prognosis in order to identify children at risk of recidivism.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Otolaryngology, Hsinchu Armed Force Hospital, Hsinchu, Taiwan, ROC; Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, ROC. Electronic address: drkuochinlung@gmail.com.
authors.forename: Chin-Lung
authors.initials: CL
authors.lastname: Kuo
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: An-Suey
authors.initials: AS
authors.lastname: Shiao
authors.affiliation: ESTAT Statistical Consulting Center, Taipei, Taiwan, ROC.
authors.forename: Chien-Hao
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. Electronic address: cflien@vghtpe.gov.tw.
authors.forename: Chiang-Feng
authors.initials: CF
authors.lastname: Lien
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D004429:Ear Ossicles; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008876:Middle Ear Ventilation; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Children; Cholesteatoma; Classification; Recurrence; Staging