Mapping the ChOLE classification to hearing outcomes and disease-specific health-related quality of life
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OTOLOGY
Mapping the ChOLE classification to hearing outcomes and disease‑specific health‑related quality of life Nora M. Weiss1 · David Bächinger2,3 · Adrian Rrahmani3 · Hans E. Bernd1 · Alexander Huber2,3 · Robert Mlynski1 · Christof Röösli2,3 Received: 15 January 2020 / Accepted: 20 April 2020 © The Author(s) 2020
Abstract Objectives To investigate the association between the “ChOLE” classification, hearing outcomes and disease-specific healthrelated quality of life (HRQoL). Methods In two tertiary referral centers, patients requiring primary or revision surgery for cholesteatoma were assessed for eligibility. Audiometric assessment was performed pre- and postoperatively. The ChOLE classification was determined intraoperatively and via the preoperative CT scan. HRQoL was assessed pre- and postoperatively using the Zurich Chronic Middle Ear Inventory (ZCMEI-21). Results A total of 87 patients (mean age 45.2 years, SD 16.2) were included in this study. ChOLE stage I cholesteatoma was found in 8 (9%), stage II cholesteatoma was found in 65 (75%), and stage III cholesteatoma was found in 14 (16%) patients. Postoperatively, the mean air–bone gap (0.5, 1, 2, 3 kHz) was significantly smaller than before surgery (14.3 dB vs. 23.0 dB; p = 0.0007). The mean ZCMEI-21 total score significantly decreased after surgery (26.8 vs. 20.7, p = 0.004). No correlation between the ZCMEI-21 total score and both the ChOLE stage and the extent of the cholesteatoma (ChOLE subdivision “Ch”) was found. A trend towards worse HRQoL associated with a poorer status of the ossicular chain (ChOLE subdivision “O”) was observed. The audiometric outcomes were not associated with the extent of the cholesteatoma. The ChOLE subdivision describing the ossicular status showed a strong association with the pre- and postoperative air conduction (AC) thresholds. Further, the ZCMEI-21 total score and its hearing subscore correlated with the AC thresholds. Conclusion The ChOLE classification does not show a clear association with HRQoL measured by the ZCMEI-21. The HRQoL neither seems to be associated with the extent of the disease nor with the ossicular chain status. Yet, surgical therapy significantly improved HRQoL by means of reduced ZCMEI-21 total scores, which were strongly associated with the AC thresholds. Intraoperative assessment of a cholesteatoma using the ChOLE classification and HRQoL complement each other and provide useful information. Keywords Tympanoplasty · Cholesteatoma · Quality of life · ChOLE classification · Staging · ZCMEI-21
Introduction
* Nora M. Weiss nora‑[email protected]‑rostock.de 1
Department of Oto‑Rhino‑Laryngology, Head and Neck Surgery “Otto Körner”, Rostock University Medical Center, Doberaner Strasse 137‑139, 18057 Rostock, Germany
2
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
3
University of Zurich, Zurich, Switzerland
Cholesteatoma is a progressive disease that may impair the patient’s quality of life [1] and bears the risk of
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