Learning Objectives: Competing surgical techniques and new modes of ossiculoplasties necessitate the uniform classification of cholesteatomas worldwide. We present a ChOLE staging system based on the extension, ossicular chain involvement, complications and pneumatization & ventilation of the temporal bone.

Competing surgical techniques and new modes of ossiculoplasties necessitate the uniform classification of cholesteatomas worldwide. Whereas the pathogenesis remains a topic of debate, the extent of middle ear & temporal bone cholesteatomas should be determined and the involvement of the ossicular chain verified. Intra- and extracranial complications are rare in well-developed countries, but challenge surgeons in more remote areas. The extent of pneumatization and ventilation of the temporal bone implicating the function of the Eustachian tube are frequently discussed, but have never been thoroughly addressed. Our ChOLE-Classification condenses Ch for cholesteatoma extension, O for ossicular chain status, L for Life threatening complications and E for Eustachian tube function. We present our experience with a retrospective review of 100 consecutive patients and a 9.5 years follow-up.