A Revised CAO Staging Classification to Predict the Prognosis of Acquired Cholesteatoma in Children

Objectives:A CAO (cholesteatoma extent, atelectasis degree and ossicle involvement) staging system for cholesteatoma was described at the XIII World Congress of Otorhinolaryn-gology in Florida in 1985. Because of 30 years of accumulated clinical data, we propose a revised and simplified model of stratification. This study aimed to investigate the prognosis of pediatric acquired cholesteatoma based on this revised staging system.Methods:Between 1982 and 2012, 132 ears in 128 children (≤18 years of age) with acquired cholesteatomas after primary surgery were included. Each case was scored for cholesteatoma extent, history of grommet insertion, age, ossicular destruction, and otorrhea. The total score classified the patients as stage I (5-6 points), stage II (7-9 points) or stage III (10-12 points). The staging system was applied to the first (66 ears) and second (66 ears) halves of the cohort, and the entire cohort (132 ears). Differences between stages were compared using Kaplan-Meier cumulative recidivism...