Surgical strategies for external auditory canal cholesteatoma based on the He staging system: a retrospective study
- 1Department of Otolaryngology & Head and Neck Surgery, Wuhan No.1 Hospital (Wuhan Hospital of Integrated Traditional Chinese and Western Medicine), No. 215 Zhongshan Avenue, Qiaokou District, Wuhan, Hubei Province 430022 China
- 2Department of Otolaryngology & Head and Neck Surgery, Jianshi County People’s Hospital, Jianshi, China
Abstract
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.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00405-026-10510-7.
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BibTeX
@article{yao2026surgical,
title = {{Surgical strategies for external auditory canal cholesteatoma based on the He staging system: a retrospective study}},
author = {Linli Yao and Xin Lin and Yuchao Liu and Peiyu Du and Yuan Tan and Shangkun Lei and Chunli Li and Pei Chen},
journal = {European Archives of Oto-Rhino-Laryngology},
year = {2026},
month = aug,
doi = {10.1007/s00405-026-10510-7},
url = {https://doi.org/10.1007/s00405-026-10510-7},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Surgical strategies for external auditory canal cholesteatoma based on the He staging system: a retrospective study
AU - Linli Yao
AU - Xin Lin
AU - Yuchao Liu
AU - Peiyu Du
AU - Yuan Tan
AU - Shangkun Lei
AU - Chunli Li
AU - Pei Chen
PY - 2026
DA - 2026/08/03
JO - European Archives of Oto-Rhino-Laryngology
DO - 10.1007/s00405-026-10510-7
UR - https://doi.org/10.1007/s00405-026-10510-7
AB - 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. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00405-026-10510-7.
SN - 0937-4477
SN - 1434-4726
ER -