The Application of Laser Technology in Cholesteatoma Surgery: Systematic Review and Meta-analysis

To evaluate the effectiveness of laser-assisted cholesteatoma surgery compared with conventional techniques, with a focus on residual disease, postoperative complications, and hearing preservation. A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases were searched for studies comparing laser and non-laser cholesteatoma surgery. Eligible studies were screened, and risk ratios (RR) with 95% CI were calculated using a random-effects model. Three studies including 271 participants reported residual disease outcomes. The pooled risk ratio was RR = 0.53; 95% CI, 0.12-2.39; P = .406, indicating no statistically significant difference between laser and non-laser groups. Moderate heterogeneity was observed (I2 = 63.5%). Only 1 study reported postoperative complications, with RR = 1.04; 95% CI, 0.18-5.97. A subgroup analysis from 1 study compared laser myringotomy with endaural laser-assisted single-stage inside-out cholesteatoma, showing RR = 0.57; 95% CI, 0.15-2.19. Laser-assisted cholesteatoma surgery demonstrates comparable rates of residual disease and complications to conventional surgery. While lasers may offer technical advantages, current evidence is limited and underpowered. Larger, high-quality trials are needed to clarify their role in cholesteatoma management.