Key Interventions Related to Middle Ear Cholesteatoma: A Systematic Umbrella Review

Area of Science:

• Otolaryngology
• Evidence-based medicine
• Systematic reviews

Background:

• Cholesteatoma poses a significant global health burden.
• Effective interventions are crucial for preventing, diagnosing, and managing this condition.
• The World Health Organization (WHO) Package of Ear and Hearing Care Interventions (PEHCI) requires evidence-based support.

Purpose of the Study:

• To conduct a systematic umbrella review of interventions for cholesteatoma.
• To identify evidence for preventing, diagnosing, and managing cholesteatoma.
• To inform the development of the WHO PEHCI.

Main Methods:

• Systematic umbrella review of systematic reviews.
• Searched MEDLINE, Scopus, and PubMed (January 2025).
• Included reviews published from 2014 onwards, assessed quality using AMSTAR 2, with two independent reviewers.

Main Results:

• Included 10 systematic reviews from 173 initial results.
• One review focused on diagnosis; nine focused on surgical interventions.
• Key interventions: non-echo-planar diffusion-weighted imaging for diagnosis; canal wall down mastoidectomy and endoscopic ear surgery for management.

Conclusions:

• Identified evidence-based interventions for cholesteatoma.
• Findings will guide the WHO PEHCI development.
• Aims to integrate ear and hearing services into national health systems for broader patient benefit.