Learning Objectives:

Introduction: External auditory canal cholesteatoma (EACC) is a relatively rare disease and its etiology is uncertain. There seem no guidelines of its management throughout the world.

Methods: Eighteen ears of 17 cases with EACC, which we operated during the past 6 years, were reviewed on its extension and management.

Results: The median age was 58 years old (16–80). There are 4 males (1 with bilateral EACC) and 13 females. Preoperative CT showed the lesion localized in the EAC in 18 ears; only bony erosion in 5 ears and bony destruction in 13 ears. Out of 13 ears, extension to the middle ear was found in 2 ears, to the mastoid in 2 ears, and to the both in 2 ears. Canaloplasty alone was performed in 8 ears. Canaloplasty with mastoidectomy was performed in 1 ear. Tympanoplasty was performed in 9 ears; type I in 6, type IIIc in 2, and type W0 (without ossiculoplasty) in 1.

Discussion: Although Naim et al reported a classification of EACC based on macroscopic and histological criteria, we here propose alternative, more simple classification based on its extension and treatment modalities; Stage 0 : only surface lesion without bony lesion, Stage I: only bony erosion , Stage II: bony deficit localized in the external auditory canal, Stage III: invasion into the tympanic cavity (T), mastoid (M) or combined (T + M), Stage IV: the adjacent anatomical structure complications (e.g. facial palsy (FP), labyrinthine fistula (LF), petrous bone/skull base destruction (PB), and temporo-mandibular joint destruction (TJ)) Following our classification, there are 5 ears in Stage I, 7 in Stage II, 6 in Stage III (2 in T, 2 in M, and 2 in T + M), 0 in Stage IV. Conservative treatment is recommended in cases of Stage I EACC. For Stage II cases with severe otorrhea, canaloplasty may be needed. Cases of Stage III need tympanoplasty, mastoidectomy, or the both. Treatment for Stage IV cases needs more argument.

Conclusion: More clinically applicable classification of EACC is proposed.