| |
Dear Respondents
Thank you for your cooperation and participation in the survey so far. You will be asked to complete a revised survey that asks questions concerning definition and classification of cholesteatoma again. We did not obtain an agreement concerning previous suggested classifications of cholesteatoma. Therefore we ask respondents to consider a new classification made by the authors based on Tos, Lau and Mills. It will take a few minutes to complete the questionnaire - this time we have prepared shortened and only one. Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. It is very important for us to learn your opinions.
Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Prof. Ewa Olszewska by email [email protected]
Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below
|
| |
|
|
|
| |
| 1. Acquired cholesteatoma is a subcategory of chronic suppurative otitis media. |
| |
|
|
|
|
| |
| 2. Cholesteatoma is a mass formed by the keratinizing squamous epithelium, subepithelial connective tissue and progressive accumulation keratin debris with surrounding inflammatory reaction. |
| |
|
|
|
|
| |
3. Acquired cholesteatoma is characterized by clinical symptoms that are the result of growth and destruction of the adjacent structures:
- ± tympanic membrane perforation
- ± otorrhea
- ± hearing deterioration
and/or CT findings (soft tissue masses, focal areas of bony erosion of the middle ear and mastoid). |
| |
|
|
|
|
| |
| 4. The term "chronic suppurative otitis media with or without cholesteatoma” is proper. |
| |
|
|
|
|
| |
| 5. Cholesteatoma consists of: matrix (keratinizing squamous epithelium), perimatrix (varying thickness of subepithelial connective tissue) and keratin debris. |
| |
|
|
|
|
| |
| 6. Definition of cholesteatoma is limited with incomplete understanding of physiopathology of the disease. |
| |
|
|
|
|
| |
| 7. Recurrent infections and inflammatory reaction at the subepithelial connective tissue of cholesteatoma contribute to the bone resorption in the adjacent area. |
| |
|
|
|
|
| |
| 8. Cholesteatoma is diagnosed by detailed otologic history, physical examination with otoscopy and/or otomicroscopy with or without imaging. |
| |
|
|
|
|
| |
| 9. Cholesteatomas are classified into two general categories: congenital and acquired. |
| |
|
|
|
|
| |
| 10. Acquired cholesteatoma is associated with either a perforation or a retraction pocket of the tympanic membrane as well as implantation from trauma or iatrogenic. |
| |
|
|
|
|
| |
| 11. Acquired cholesteatoma with ear drum perforation develops from keratinizing squamous epithelium of the external layer of the tympanic membrane or external ear canal or cellular change in middle ear. |
| |
|
|
|
|
| |
| 12. Acquired cholesteatoma with retraction pocket originates from the external layer of the tympanic membrane retraction pocket, when the retraction pocket looses its ability to self clean and starts filling with keratin debris. |
| |
|
|
|
|
| |
| 13. Acquired cholesteatoma is not present at birth. |
| |
|
|
|
|
| |
| 14. Acquired cholesteatomas may be primary or secondary. |
| |
|
|
|
|
| |
| 15. Primary acquired cholesteatoma develops from retraction pocket of pars flaccida, pars tensa or both and is a sequela of middle ear isobaric system dysfunction. |
| |
|
|
|
|
| |
| 16. Secondary acquired cholesteatoma may develop secondary to the tympanic membrane perforation as a result of acute or chronic otitis media, ear trauma or may be iatrogenic. |
| |
|
|
|
|
| |
| 17. Congenital cholesteatoma is an expanding cystic mass with keratinizing squamous epithelium located medial to intact tympanic membrane, assumed to be present at birth but usually diagnosed during infancy or in early childhood in patients with no prior history of otorrhea, perforation or previous ear surgery. |
| |
|
|
|
|
| |
| 18. A history of previous bouts of otitis media or an effusion does not exclude a congenital cholesteatoma. |
| |
|
|
|
|
| |
| 19. Congenital cholesteatoma is usually located at the antero-superior quadrant of the middle ear. However, it may be located at the posterosuperior quadrant and other intracranial locations. |
| |
|
|
|
|
| |
| 20. The clinical presentation of congenital cholesteatoma is determined by the location and extent of the lesion. It may be characterized by: -± abnormal otoscopic examination (white mass medial to an intact tympanic membrane) -± rarely with conductive hearing loss when enlarged to fill the middle ear or erodes the ossicles -± extremely rarely with pain and/or CT findings (usually as a round soft tissue mass at the anterior superior quadrant, rarely with bony erosion). |
| |
|
|
|
|
| |
| 21. Precholesteatoma is a stage of retraction pocket with not completely visible depth, with early signs of self cleaning disability and without tympanic cavity lesions and temporal bone erosion. |
| |
|
|
|
|
| |
| 22. Cholesteatoma recurrence is the redevelopment of cholesteatoma at the same site or in another location after previous surgical removal. It occurs after a period of time in which no cholesteatoma could be detected. |
| |
|
|
|
|
| |
| 23. Cholesteatoma recurrence may be diagnosed as “residual cholesteatoma” or ”recurrent cholesteatoma”. |
| |
|
|
|
|
| |
| 24. Residual cholesteatoma is due to incomplete primary removal of the epidermal matrix at the time of surgery. |
| |
|
|
|
|
| |
| 25. Recurrent cholesteatoma is a redevelopment of cholesteatoma after surgical removal as a result of a new pathological process of the tympanic membrane and middle ear isobaric system dysfunction. |
| |
|
|
|
|
| |
26. New classification based on Lau, Tos [J Laryngol Otol. 1989 Feb;103(2):149-57] and Mills [J Laryngol Otol. 1991 May;105(5):343-5] classifications and suggestions of respondents, proposed by the authors:
"1. Acquired attic cholesteatoma - retraction or perforation of the pars flaccida or Shrapnell membrane; cholesteatoma extending to the attic, going through the aditus and eventually reaching the antrum, mastoid or tympanic cavity.
2. Acquired tympanic sinus cholesteatoma - retraction or perforation of posterior-superior pars tensa, cholesteatoma extending to the tympanic sinus and posterior portion of the tympanic membrane.
3. Acquired tensa cholesteatoma – retraction, perforation or total adhesion of the pars tensa of tympanic membrane involving the tympanic orifice of the auditory tube
4. Congenital cholesteatoma - cholesteatoma located medial to intact tympanic membrane
5. Recurrent/residual cholesteatoma - redevelopment of cholesteatoma at the same site or in another location after previous surgical removal
is useful in clinical practice.
|
| |
|
|
|
|
| |
27. New clinical staging system for cholesteatoma, based on JOS staging system [Japan Otological Society, 2008 Otol JPn, 18, 611-5] and Bluestone's classification of cholesteatoma in 2003, and suggestions of respondents, proposed by the authors:
Stage I – middle ear and mastoid cell system involved cholesteatoma without bone erosion
Stage II – cholesteatoma causes temporal bone erosion without following complications : 1.facial palsy 2.Intracranial complication 3.labyrynthine fistule 4.large defect of bony external ear canal 5.profound sensorineural hearing loss 6.total adhesion of the ear drum
Stage III – any cholesteatoma causing at least one of the following complications : 1.facial palsy 2.Intracranial complication 3.labyrynthine fistule 4.large defect of bony external ear canal 5.profound sensorineural hearing loss 6.total adhesion of the ear drum
is useful in clinical practice. |
| |
|
|
|
|
Loading...
