Value of Endoscopy in Cholesteatoma Clearance: A Systematic Review

Introduction: The primary goal of cholesteatoma surgery is to eradicate it from the middle ear cleft. However due to linear axis of illumination of the microscope, in some of the recesses or hidden areas in middle ear are not visualised. To overcome this many studies have been done on the complimentary use of endoscopes in visualising these hidden areas. Aim: To assess the outcome of complimentary use of endoscopes in addition to microscope on improved access to hidden areas in the middle ear and resultant cholesteatoma clearance. Materials and Methods: In this systematic review, Literature search was conducted using the key words both manually and electronically in PubMed, Google scholar and Directory of Open Access Journals for articles published till December 2021 at ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India. The primary inclusion criteria used was all full text original, both prospective and retrospective, articles in which endoscopes were used as an adjunct to microscope for cholesteatoma clearance from middle ear cleft. Retrieved articles were reviewed by two independent authors for their eligibility for inclusion in the study. The selected original papers were analysed. Data was entered in Microsoft Excel 2007 and analysed for descriptive statistics like frequency and proportions. Results: A total of 48 studies were identified initially. After removing duplicates, screening was done for title, abstracts and full text retrieval to check for inclusion criteria being met. Six studies were found using complimentary endoscopes for cholesteatoma surgery and were analysed. Of these four were prospective and two were retrospective studies. Total 604 patients underwent endoscopic examination after microscopic clearance. Residual cholesteatoma was seen in 105 patients (17%), which were cleared with endoscopic assistance. Conclusion: Complimentary endoscopy detects residual cholesteatoma in significant number of cases during primary cholesteatoma surgery. In cholesteatoma surgery they are predominantly used as observational tools.