Middle Ear Cholesteatoma Treated with a Mastoidectomy: A Systematic Review of the Measures Used

• Published in: Otolaryngology-head and neck surgery 2014-12, Vol.151 (6), p.923-929
• Main Authors: Mor, Niv, Finkel, Dina A., Hanson, Matthew B., Rosenfeld, Richard M.
• Format: Article
• Language: English
• Subjects: cholesteatoma; Cholesteatoma, Middle Ear - diagnosis; Cholesteatoma, Middle Ear - surgery; Female; Follow-Up Studies; Humans; Male; Mastoid - surgery; mastoidectomy; measures; Otologic Surgical Procedures - adverse effects; Otologic Surgical Procedures - methods; outcomes; Postoperative Complications - physiopathology; Randomized Controlled Trials as Topic; Risk Assessment; Severity of Illness Index; Treatment Outcome
• ISSN: 0194-5998; 1097-6817; 1097-6817
• DOI: 10.1177/0194599814549547

Objectives The inconsistent measures used to report outcomes after mastoidectomy to treat cholesteatoma make it impossible for clinicians to compare results and apply them appropriately to patient care. We sought to identify and assess the type and relative frequency of the reported measures. Data Sources PubMed, EMBASE, the Web of Science. Review Methods We searched 3 independent databases for articles that reported outcomes of middle ear cholesteatoma treated with mastoidectomy. Articles were assessed for eligibility using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and data were extracted by 2 independent investigators. Observational studies and randomized controlled trials from the past 30 years were included. Articles with less than 50 subjects and nonsurgical studies were excluded. The measures used by each study were recorded, and the relative frequency of each measure was calculated. Results Forty-three of 380 articles met criteria. Time to follow up was inconsistent. Most articles reported on preoperative qualitative parameters (77%); however, few reported on the severity of disease (19%) or formally staged the disease (12%). Not all studies reported on the presence of recurrent or residual disease (88%) or the postoperative audiogram results (70%). Only 12% presented results as a Kaplan-Meier disease-free curve. Most studies reported on complications (70%). Conclusion Reported measures were inconsistent among the studies, which makes comparisons between studies unreliable. Standardization will optimize future reporting and will allow for the establishment of best practices.