Comparison of Endoscopic and Microscopic Management of Attic Cholesteatoma: A Systematic Review and Meta-Analysis

The differences in the outcomes between the totally endoscopic approach and the traditional microscopic approach remain unclear for limited attic cholesteatomas. This systematic review and meta-analysis aim to compare the outcomes of the endoscopic approach and the microscopic approach for the management of cholesteatoma limited to the attic.

Searches were performed using PubMed, Cochrane Library, Web of Science, Clinical Trials, and Google Scholar.

This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol 2020 guidelines. Studies were included based on predefined eligibility criteria and assessed for quality using the revised Cochrane risk-of-bias 2 tool and the Methodological Index for Non-Randomized Studies criteria. The primary outcomes for this review were audiological outcomes, healing time, operating time, middle ear structures visibility index (MESVI), postoperative complications, and long-term outcomes.

Seven studies with a total of 539 patients (541 operated ears) were included. The endoscopic group had a statistically significantly higher MESVI (Z = 23.205, P < .0001). The overall effect showed less postoperative pain among patients undergoing the endoscopic technique (Z = -6.942, P = .000). No statistically significant difference between both groups was found in terms of healing time, operating time, postoperative complications and audiological outcome.

The endoscopic approach for the management of cholesteatoma limited to the attic region has some advantages compared to the microscopic approach, namely in terms of better middle ear structures visibility and less postoperative pain. Future research conducted with high-quality comparative prospective studies is needed to further compare both surgical approaches and confirm the advantages of the endoscopic approach.