Subtotal Petrosectomy and Cochlear Implantation: A Systematic Review and Meta-analysis

Area of Science:

• Otolaryngology
• Neurosurgery
• Audiology

Background:

• Subtotal petrosectomy (STP) is increasingly utilized for cochlear implantation in ears with challenging conditions.
• This systematic review evaluates the indications, complications, and outcomes of STP in preparation for cochlear implantation.

Purpose of the Study:

• To review indications and complications associated with subtotal petrosectomy (STP) and cochlear implantation.
• To compare outcomes of single-stage versus multi-stage procedures.
• To compare outcomes between pediatric and adult populations.

Main Methods:

• A comprehensive literature search was conducted across major databases (PubMed, Scopus, Ovid, Cochrane Library) up to January 2020.
• Twenty-seven studies involving 377 patients and 397 STP procedures were included based on predefined criteria.
• Data on patient demographics, indications, complications, and cholesteatoma recurrence were extracted and analyzed.

Main Results:

• The most common indications for STP were chronic otitis media (55.4%), previous open mastoid cavity (35.5%), and cholesteatoma (18.6%).
• The overall complication rate was 12.4%, with a cholesteatoma recurrence rate of 9.3%.
• Complication rates did not significantly differ between single-stage and multi-stage procedures or between pediatric and adult patients.

Conclusions:

• Subtotal petrosectomy (STP) is an effective procedure for preparing unfavorable ears for cochlear implantation across all age groups.
• STP expands the candidacy for cochlear implantation and can be safely performed in children.
• The presence of cholesteatoma may warrant a multi-stage surgical approach.