Surgical strategies for external auditory canal cholesteatoma based on the He staging system: a retrospective study

PURPOSE: To investigate individualized surgical treatment strategies and clinical management experience for external auditory canal cholesteatoma (EACC) based on the He staging system. METHODS: Clinical data from 59 patients (61 ears) with EACC who underwent surgical treatment at Wuhan No. 1 Hospital from September 2019 to July 2025 were retrospectively analyzed. All patients underwent a preoperative temporal bone computed tomography (CT) examination and were staged according to the He staging system (Stage I, 8 ears; Stage II, 33 ears; Stage IIIA, 11 ears; Stage IIIB, 5 ears; and Stage IIIC, 4 ears). Individualized surgeries, including lesion resection via endoscopic ear surgery, canaloplasty, tympanoplasty, and mastoid surgery, were performed accordingly. Regular postoperative follow-up was conducted to evaluate therapeutic outcomes and complications. RESULTS: Postoperative pathological examinations confirmed cholesteatoma in all patients. During the follow-up period of 7 months to 2 years, recurrence occurred in 2 ears (3.28%, both of which were Stage II cases), which were cured after revision surgery. Postoperative complications included external auditory canal infection in 3 ears (4.92%) and restenosis in 2 ears (3.28%), all of which resolved after appropriate management. Additionally, 3 ears (4.92%) exhibited wide external auditory canal cavities postoperatively, with one accompanied by meatal stenosis. Among these patients, two improved after the application of topical medication and close follow-up, while one developed mild facial palsy (House-Brackmann grade II) triggered by acute external otitis and recovered well after revision canaloplasty, with a satisfactory cavity morphology. CONCLUSION: The He staging system provides practical guidance for preoperative evaluations and the formulation of surgical strategies for patients with EACC. Stage-based individualized surgery effectively achieves lesion clearance and reduces recurrence rates. Intraoperative attention to the external auditory meatus and postoperative recognition of and intervention in the "sequelae stage" are crucial for ensuring favorable long-term outcomes.