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

This systematic umbrella review aimed to identify current evidence for the interventions to prevent, diagnose, and/or manage cholesteatoma. Results from this review will inform the development of the World Health Organization (WHO) Package of Ear and Hearing Care Interventions (PEHCI). The PECHI will describe priority interventions that can be integrated into health systems to reduce the global burden of otologic conditions.

We searched Ovid MEDLINE, Scopus, and PubMed in January 2025 to identify systematic reviews describing interventions for cholesteatoma.

Reviews published in 2014 or later were included. We assessed the quality of the reviews using the AMSTAR 2 tool, and studies were included if they met 6 prespecified critical domains. Two independent reviewers conducted all review processes.

The initial search yielded 173 nonduplicate systematic reviews. Ultimately, 10 reviews were included for data extraction and synthesis. One article focused on diagnostic interventions, and the remaining 9 focused on surgical interventions. The key identified interventions include (1) use of non-echo-planar diffusion weighted imaging (a type of magnetic resonance imaging) to diagnose recurrent or residual cholesteatoma, and in terms of surgical management, (2) canal wall down mastoidectomy, and (3) endoscopic ear surgery. Other identified interventions were relevant to subgroups of patients with cholesteatoma.

This umbrella review identified evidence-based interventions related to cholesteatoma. These interventions will help inform the development of the WHO PEHCI, which aims to promote integration of ear and hearing services into national health systems and policies, ultimately allowing more individuals to benefit from these critical services.