SRS209 - Evaluating EAONO staging as a predictor of cholesteatoma recurrence: a UK tertiary centre experience

Abstract Introduction Cholesteatoma is a locally invasive and destructive lesion formed from keratinizing squamous epithelium. If untreated, it can lead to severe complications including imbalance, hearing loss, facial nerve weakness and meningitis. Surgical excision is the mainstay of treatment; however, patients remain at risk of residual or recurrent disease requiring long-term surveillance with clinical examination and MRI. Prognostic scoring systems such as the European Academy of Otology and Neurotology (EAONO), Japanese Otological Society (JOS), and the STAM classification aim to stratify recurrence risk, though their effectiveness remains uncertain. Aims This study is the first in the UK to assess the correlation between EAONO staging and post-operative MRI on the rate of residual and recurrent disease. Methods A retrospective case review was undertaken of all primary and revision cholesteatoma surgeries performed by a single surgeon between October 2021 and January 2025. Results Ninety-one cases were analysed. Eleven patients had positive post-operative MRI scans, comprising eight recurrences and four cases of residual disease. MRI positivity rates by EAONO stage were 6% for stage 1, 22% for stage 2, and 20% for stage 3. While stage 1 was associated with a lower likelihood of residual or recurrent disease, no statistically significant difference was observed between stages 2 and 3. Conclusions EAONO stage 1 patients have better outcomes with a lower risk of residual or recurrent cholesteatoma. However, higher stages did not significantly correlate with recurrence risk, suggesting limited value of EAONO staging as a prognostic tool beyond stage 1.