The classification of tympanomastoid surgery for cholesteatoma by the new SAMEO-ATO system in clinical practice
Abstract
Introduction: The SAMEO-ATO system established by IOOG consensus in 2018 introduces a new, complex, and unified classification of middle ear surgery. This system is generally suitable for various surgical procedures in the middle ear.
The main goal of this work is to present our experience of using the new classification system in the clinical practice focusing on cholesteatoma surgery. Methods: We have retrospectively classified the group of patients who underwent surgery for chronic otitis media with cholesteatoma between 2013 and 2017.
Results: We classified 142 cholesteatoma surgeries carried out on 104 patients (56 men and 48 women at the age 5-77 years, with the mean 33 years and the median 27 years) using the SAMEO-ATO classification. There were 77 primary surgeries (S1), 40 second-look surgeries (S2p) and 25 secondary surgeries for recidivism (S2r).
There was a 50% (20) incidence of recurrent cholesteatoma in S2p surgeries and 76% (19) incidence of residual cholesteatoma in S2r. We have further evaluated our group of patients by each SAMEO-ATO subclassification.
In the mastoid part of surgery (parameter "M"), the combination of M1a + 2a (N = 49, 34.51%) was most frequent, followed by M2c (N = 25, 17.61%), M2a (N = 20, 14.08%), M1a (N = 4, 2.82%), M2b (N = 5, 3.52%), M3a (N = 3, 2.11%) and M3b (N = 1, 0.70%). In the ossicular reconstruction (parameter "O"), the most frequent was Osd (N = 58, 40.85%), followed by Ost (N = 21, 14.79%), Oft (N = 19, 13.38%), Ofd (N = 5, 3.52%) and Osm (N = 5, 3.52%).
Conclusions: The SAMEO-ATO classifies various surgical techniques of cholesteatoma removal as well as reconstruction of the ossicular chain. It allows the creation of a unified database of patients who underwent middle ear surgery and the comparison of the results of different surgery techniques among various departments.
The collected data are applicable for research purposes.