Table 2. Summary of diagnostic and therapeutic strategies by stage of external auditory canal cholesteatoma (EACC)

Stage	Clinical Findings	CT Findings	Treatment Approach	Prognosis & Recurrence
I	Mild symptoms (ear fullness, hearing loss), intact TM	Localized soft tissue in EAC, minimal erosion	Transcanal cholesteatoma removal (TCR)±canaloplasty	Excellent prognosis, recurrence <10%
II	Otorrhea, moderate erosion, possible TM retraction	Bony erosion of canal walls (commonly posterior/inferior)	TCR+canaloplasty±cartilage graft	Good prognosis if complete removal; monitor for recurrence
IIIA	Otorrhea, hearing loss, deeper canal erosion	Erosion into middle ear cavity, ossicular erosion	Tympanoplasty±ossiculoplasty	Moderate recurrence risk; close follow-up required
IIIB	Persistent otorrhea, postauricular tenderness	Extension into mastoid, sequestra possible	Mastoidectomy+canaloplasty±Open cavity technique	Moderate recurrence risk; close follow-up required
IIIC	Extensive otorrhea, hearing loss, possible facial nerve involvement	Combined middle ear+mastoid destruction	Combined tympanoplasty, mastoidectomy, canaloplasty	High risk of recurrence and complications (up to 30–40%)
IV	Facial palsy, dizziness, systemic symptoms	Invasion beyond temporal bone, skull base involvement	Extended resection with neurosurgical collaboration	Prognosis poor, high morbidity; individualized care

CT: computed tomography, TM: Tympanic Membrane, EAC: external auditory canal.