Endoscopic-Guided Resection of Middle Ear Cholesteatoma: A Systematic Review and Meta-Analysis.

Objective: The study aimed to compare the effectiveness of endoscopic-guided versus microscopic endaural and canal wall up approaches in the resection of middle ear cholesteatoma in both adult and pediatric patients.

Methods: A comprehensive search was conducted in PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to April 2024, covering studies published between 2004 and 2024. Cohort and randomized trials addressing middle ear cholesteatoma resection were included. Excluded were studies with unequal disease extent, canal wall down surgeries, other unrelated otological procedures, and nonlongitudinal studies. Screening of studies and assessment of the risk of bias were performed independently by two pairs of blinded authors. Data abstraction adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Results: A total of 1,134 cases from 13 studies were included. In the endoscope group, there was a significant reduction in the risk of residual cholesteatoma (RR, 0.65; 95% CI, 0.47-0.89). No significant differences were observed between the groups for postoperative tympanic membrane perforation or cartilage graft displacement. Similarly, postoperative complications, such as disturbances in taste sensation and transient vertigo, did not differ significantly between the two approaches.

Conclusions: Endoscopic-guided resection is superior to microscopic surgery in terms of residual cholesteatoma resection, with no significant difference in postoperative complications or tympanic membrane status.