Potsic Staging System for Congenital Cholesteatoma

The Potsic Staging System is used to predict the likelihood of residual disease in the context of congenital cholesteatoma.¹
- Stage I: Disease confined to a single quadrant of the middle ear.
- Stage II: Cholesteatoma in multiple quadrants, but with no ossicular involvement and no mastoid extension.
- Stage III: Ossicular involvement without mastoid extension.
- Stage IV: Mastoid disease.
As per Potsic’s classification, there was a strong association between stage and residual disease, with a 13% risk of residual disease at Stage I, versus 67% at Stage IV.
Diagnosis of congenital cholesteatoma is usually based on Levenson’s Criteria² (which was a modification of the Derlacki and Clemis criteria³ in 1986).

Potsic Staging for congenital cholesteatoma

Stage	Features
Stage I	Confined to a single quadrant with no ossicular involvement and no mastoid involvement.
Stage II	Involving multiple quadrants with no ossicular involvement and no mastoid involvement.
Stage III	Ossicular involvement with no mastoid involvement.
Stage IV	Mastoid involvement.

Potsic, William P., et al. “A staging system for congenital cholesteatoma.” Archives of Otolaryngology–Head & Neck Surgery 128.9 (2002): 1009-1012. ↩
Levenson, Mark J., et al. “A review of twenty congenital cholesteatomas of the middle ear in children.” Otolaryngology—Head and Neck Surgery 94.5 (1986): 560-567. ↩
Derlacki, Eugene L., and Jack D. Clemis. “LX congenital cholesteatoma of the middle ear and mastoid.” Annals of Otology, Rhinology & Laryngology 74.3 (1965): 706-727. ↩

Last updated October 11, 2022