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Auris Nasus Larynx. 2017 Apr;44(2):135-140. doi: 10.1016/j.anl.2016.06.012. Epub 2016 Sep 9.

Staging and classification criteria for middle ear cholesteatoma proposed by the Japan Otological Society.

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Department of Otolaryngology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan. Electronic address:
Department of Otolaryngology, Hyogo College of Medicine, Kobe, Japan.
Department of Otolaryngology, Jikei University School of Medicine, Tokyo, Japan.
Department of Otolaryngology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Department of Otolaryngology, National Center for Child Health and Development, Tokyo, Japan.
Department of Otolaryngology, Ehime University School of Medicine, Ehime, Japan.
Department of Otolaryngology, Faculty of Medicine, Niigata University, Niigata, Japan.
Department of Otolaryngology, National Sendai Medical Center, Sendai, Japan.


In order to provide a basis for meaningful exchange of information among those treating cholesteatoma, the Committee on Nomenclature of the Japan Otological Society (JOS) was appointed in 2004 to create a cholesteatoma staging system as simple as possible to use in clinical practice in Japan. Following the announcement of preliminary criteria for the staging of pars flaccida (attic) cholesteatoma in 2008, we proposed the 2010 JOS staging system for two major types of retraction pocket cholesteatoma, pars flaccida and pars tensa cholesteatoma. Since then, the JOS staging system has been widely used in clinical studies of cholesteatoma in Japan, allowing standardization in reporting of surgical outcomes based on the respective stages of cholesteatoma. We have recently expanded the range of cholesteatoma by adding cholesteatoma secondary to a tensa perforation and congenital cholesteatoma as the 2015 JOS staging system for middle ear cholesteatoma. Although further revisions may be required for universal acceptance of these criteria, we hope our staging system will open the way for international consensus on staging and classification of middle ear cholesteatoma in the near future.


Classification; Middle ear cholesteatoma; Staging

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