Endoscopic Versus Microscopic Approaches in Attic Cholesteatoma Resection: A Systematic Review and Meta-analysis

Monday, September 30, 2024

8:12 AM – 8:18 AM EDT

Location: MBCC, 231

Introduction: Attic cholesteatoma is a common otologic disease that can induce chronic ear inflammation. Surgical resection commonly utilizes microscopic or endoscopic techniques. Although preliminary evidence indicates potential advantages of the endoscopic approach, there is currently no consensus to switch from the traditional microscope modality to the endoscopic one.

Methods: We reviewed PubMed, Embase, and the Cochrane Central Register for studies comparing endoscopic and microscopic approaches in attic cholesteatoma without mastoid infiltration. Outcomes included were cholesteatoma recurrence, healing time, intraoperative facial nerve dehiscence, postoperative vertigo, and abnormal taste sensation. Statistical analysis used RevMan 5.4.1, assessing heterogeneity with I².

Results: We included a total of 761 cases from 8 studies. In the endoscopic group, the risk ratio (RR) was reduced for residual disease (RR 0.38; 95% CI 0.15 to 0.92; p = 0.03), and disease recurrence after approximately two years (RR 0.49; 95% CI 0.30 to 0.80; p = 0.004). However, there was no significant difference in mean difference (MD) in healing time (MD −6.40; 95% CI −16.08 to 3.24; p = 0.20). In the evaluation of intraoperative and postoperative complications, the endoscopic intervention showed no significant risk difference in facial nerve dehiscence (RR 1.31; 95% CI 0.82 to 2.10; p = 0.26), vertigo (RR 0.63; 95% CI 0.34 to 1.20; p = 0.16), and abnormal taste sensation (RR 0.89; 95% CI 0.61 to 1.32; p = 0.57).

Conclusions: Endoscopic ear surgery significantly reduces cholesteatoma recurrence after two years compared to the microscopic approach. However, there are no significant differences in healing time or intra/postoperative complications between the two methods.

Presenting Author(s)

RG

Rodolfo Baptista Giffoni

Student
Universidade Estadual de Feira de Santana
FEIRA DE SANTANA, Bahia, Brazil

Disclosure information not submitted.

Co-Author(s)

JA

Julieta Arguelles-Hernadez, MD

The University of Texas MD Anderson Cancer Center, United States

Disclosure information not submitted.
GS

Gabriele Santos

Universidade Estadual de Feira de Santana, United States

Disclosure information not submitted.
VS

Victor Sena

Universidade Estadual de Feira de Santana, United States

Disclosure information not submitted.
RA

Ricardo Aguiar

Universidade Estadual de Feira de Santana, United States

Disclosure information not submitted.
LL

Lucas Lins

Universidade Estadual de Feira de Santana, United States

Disclosure information not submitted.

Senior Author(s)

AL

Adriano Lima

Universidade de Brasília, United States

Disclosure information not submitted.