Canal Cholesteatoma Presentation and Management: A Systematic Review and Meta-Analysis

To evaluate current understanding of external auditory canal cholesteatoma (EACC), its symptomatic burden, clinical features, diagnostic approach, and management strategies to reduce delays in diagnosis.

PubMed, CINAHL, COCHRANE Library, and SCOPUS.

A comprehensive literature search was completed in March 2025. The search identified 2117 English-language articles, of which 30 studies reported patients diagnosed with EACC. Meta-analyses of mean difference (Δ), proportions (%), and continuous measures with 95% confidence intervals (CI) were performed using random and fixed effects models.

A total of 1007 patients were included with a mean age of 43.9 years (range 6-89). Most were diagnosed with Stage III EACC (60.7%, CI 43.5-76.7). Nicotine use (33.1%, CI 15.2-54.1) and cotton swab abuse (24.3%, CI 16.7-33.7) were common risk factors. Patients most often presented with otalgia (39.9%, CI 30.5-49.7) or otorrhea (50.3%, CI 37.8-62.7), though 15.7% (CI 4.5-31.6) were asymptomatic. Conservative treatment with serial debridement was used in most patients (69.6%, CI 44.5-89.7). Canalplasty (68.6%, CI 48.3-85.7), tympanoplasty (24.7%, CI 3.7-56.1), and mastoidectomy (33.7%, CI 17.4-52.3) were the most common surgical approaches. Recurrence was low (4.5%; 95% CI 2.3-8.0).

Patients with EACC are frequently diagnosed at advanced stages. Recognizing risk factors and symptoms can expedite detection and guide management. This review highlights how tailored interventions achieve low recurrence rates and reduce morbidity linked to delayed diagnosis.