The Systemic Immune Signature of Cholesteatoma: A Comprehensive Cross-Sectional Analysis of Hematological Markers and Clinical Staging.

BACKGROUND: Cholesteatoma is an inflammatory disease of the middle ear, which is characterized by hearing loss, bony destruction, and increased potential for complications. The inflammation plays a major role in the pathogenesis of disease; however, the relationship between systemic haematological inflammatory markers and disease severity remains inadequately understood. This study attempts to evaluate this association between conventional and novel inflammatory markers and the staging of cholesteatoma. METHODS: This study is a prospective cross-sectional analytical study, conducted at a tertiary care center in Central India over 18 months. Seventy-two patients with chronic otitis media (COM) squamosal disease undergoing tympanomastoid surgery and having confirmed or suspected cholesteatoma were included. The patients were further classified as per the European Academy of Otology and Neurotology/Japan Otological Society (EAONO/JOS 2017) staging system. The blood examinations done preoperatively were complete blood count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). The neutrophil-to-lymphocyte ratio (NLR) and Systemic Immune-Inflammation Index (SII) from complete blood count were calculated. Comparisons across the various disease stages were performed using the Kruskal-Wallis test, and correlations with disease stage were assessed using Spearman's rank correlation. RESULTS: The age range was 6-55 years, with a mean age of 25.36 ± 11.56 years. There was no marked gender predominance observed in the study. As per staging, stage II disease was the most common presentation seen in 40 (55.6%) cases, followed by stage III in 26 (36.1%) cases. The median values of all inflammatory markers increased progressively with advancing stage of cholesteatoma. The Systemic Immune-Inflammation Index progressively increased from 286.5 (interquartile range (IQR): 276.75-424.00) in stage I to 1304.0 (IQR: 1163.0-1445.0) in stage IV. Although the neutrophil-to-lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein showed upward trends with disease severity, interstage differences were not statistically significant. Spearman's rank correlation coefficients (ρ) between inflammatory markers for the Systemic Immune-Inflammation Index and erythrocyte sedimentation ratio demonstrated statistically significant positive correlations with advancing disease stage. CONCLUSION: The systemic inflammatory burden increases with advancing stage of cholesteatomatous otitis media. However, among the evaluated biomarkers, the Systemic Immune-Inflammation Index demonstrated the strongest and most significant association with disease severity. Hence, it has a potential utility as an inexpensive, readily available adjunctive marker for preoperative assessment and risk estimation in patients with cholesteatomatous chronic otitis media.