Skip to main content

TMC: a new staging system for tympanomastoid cholesteatoma




To present a new staging system for tympanomastoid cholesteatoma that is based on the primary site of pathology in the middle ear (T), its spread to the mastoid (M), and to the surrounding structures, either cranial, intracranial, or extracranial, and presence of complications (C).


Tertiary Care Center (ENT Department, Faculty of Medicine, University of Alexandria, Egypt).

Study design

Clinical Prospective Study.


The TMC staging system is based on the correlation of preoperative otoscopy findings with computed tomography examination of the temporal bone. Preoperative findings have also been correlated with intraoperative findings.


We included 120 patients with tympanomastoid cholesteatoma diagnosed preoperatively.


In 87% of the patients, preoperative and intraoperative staging were well correlated.


The TMC staging system of cholesteatoma paves the way to a logical roadmap for functional surgery of the middle ear and mastoid; in addition, it makes the comparison of clinical studies about cholesteatoma meaningful.


  1. Graham MD, Delap TG, Goldsmith MM. Closed tympanomastoidectomy. Otolaryngol Clin North Am. 1999; 32: 547–554

    Article  CAS  Google Scholar 

  2. Syms MJ, Luxford WM. Management of cholesteatoma: status of the canal wall. Laryngoscope. 2003; 113: 443–448

    Article  Google Scholar 

  3. Kapur TR. Causes of failure of combined approach tympanoplasty in the treatment of acquired cholesteatomas of the middle ear and the mastoid. J Laryngol Otol. 1995; 109: 710–712

    Article  CAS  Google Scholar 

  4. Reddy TN, Dutt SN, Shetty A, Maini S. Transcanal atticoaditotomy and transcortical mastoidectomy for cholesteatoma: the Farrior–Olaizola technique revisited. Ann Otol Rhinol Laryngol. 2001; 110: 739–745

    Article  CAS  Google Scholar 

  5. Uzun C, Yagiz R, Tas A, Adali MK, Koten M, Karasalihoglu AR. Combined Heermann and Tos (CHAT) technique in cholesteatoma surgery: surgical technique and preliminary results. J Laryngol Otol. 2005; 119: 429–435

    Article  Google Scholar 

  6. Dornhoffer JL. Retrograde mastoidectomy with canal wall reconstruction: a follow-up report. Otol Neurotol. 2004; 25: 653–660

    Article  Google Scholar 

  7. Olszewska E, Wagner M, Bernal Sprekelsen M, Ebmeyer J, Dazert S, Hildmann H, et al. Etiopathogenesis of cholesteatoma. Eur Arch Otorhinolaryngol. 2004; 261: 6–24

    Article  Google Scholar 

  8. Lau T, Tos M. Treatment of sinus cholesteatoma. Long-term results and recurrence rate. Arch Otolaryngol Head Neck Surg. 1988; 114: 1428–1434

    Article  CAS  Google Scholar 

  9. Sethom A, Akkari K, Dridi I, Tmimi S, Mardassi A, Benzarti S, et al. Preoperative CT scan in middle ear cholesteatoma. Tunis Med. 2011; 89: 248–253

    Google Scholar 

  10. Alzoubi FQ, Odat HA, Al Balas HA, Saeed SR. The role of preoperative CT scan in patients with chronic otitis media. Eur Arch Otorhinolaryngol. 2009; 266: 807–809

    Article  Google Scholar 

  11. Williams MT, Ayache D. Imaging in adult chronic otitis. J Radiol. 2006;87(11 C2):1743–1754

    Article  CAS  Google Scholar 

  12. Tos M, Lau T. Late results of surgery in different cholesteatoma types. ORL. 1989; 51: 33–49

    Article  CAS  Google Scholar 

  13. Meyerhoff WL, Truelson J. Cholesteatoma staging. Laryngoscope. 1986;96(9 I):935–939

    Article  CAS  Google Scholar 

  14. Saleh HA, Mills RP. Classification and staging of cholesteatoma. Clin Otolaryngol Allied Sci. 1999; 24: 355–359

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Mahmoud Reda.

Additional information

Conflicts of interest

There are no conflicts of interest.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Belal, A., Reda, M., Mehanna, A. et al. TMC: a new staging system for tympanomastoid cholesteatoma. Egypt J Otolaryngol 28, 12–16 (2012).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: