How effective is Endoscopic Ear Surgery in the management of Cholesteatoma? A Systematic Review

By June 7, 2019

Visvanathan,V.1; Vallamkondu, V.2; Bhimrao, Sanjiv K.3
1 University Hospital North Midlands NHS Trust, Royal Stoke University Hospital
2 Aberdeen Royal Infirmary
3 Royal Stoke University Hospital, University Hospitals North Midlands NHS Trust

Endoscopic Ear surgery (EES) has been in practice for nearly two decades. The advantages of EES include its minimal invasiveness and unparalleled visualisation of the middle ear and its recesses.  Despite these advantages,  how does residual/recurrence rates of EES compare against canal wall down (CWD) or canal wall up (CWU) techniques in the management of cholesteatoma?  The purpose of this study was to systematically review the literature to establish the effectiveness of EES in cholesteatoma surgery.

A comprehensive search (no date restictions) was performed using Cochrane, Embase and Pubmed.  Inclusion criteria were 1) Studies reporting Endoscopic Ear Surgery alone (EES3) or as an adjunct to microscopic ear surgery (EES 2) for treatment of middle ear/mastoid cholesteatoma 2) Primary cases 3) English articles.  The exclusion criteria for this study were 1) Articles reporting revision cases only 2) Reports discussing management of non-cholesteatoma disease 3) Non-English articles. Final search date 20th December 2018. PRISMA guidelines were used.

A total of 963 patients from 15 studies were included. Mean follow up was 25.84 months.  There were 380 and 583 patients in the EES2 and EES3 categories respectively.  343 patients were followed between 0 and 2 years, 376 patients between 2 and 4 years and 244 patients over 4 years.  Overall residual/recurrence rate was 18.69%.

All published literature is of level 4 evidence.  EES is safe and has a key role in the management of cholesteatoma.  The recurrence/residual rates of EES are comparable with CWU mastoidectomy at 2 years post surgery.  High quality controlled studies are required to demonstrate its long-term outcomes.