Health-related quality of life in patients after endoscopic or microscopic cholesteatoma surgery.

Purpose: Different surgical techniques exist for treating cholesteatoma, such as microscopical or transcanal endoscopic ear surgery (TEES). This study aimed to compare these two techniques, focusing on quality of life.

Methods: This retrospective single-center study included 188 patients with cholesteatoma. The primary outcome was the assessment of health-related quality of life (HRQoL) using the Zurich Chronic Middle Ear Inventory (ZCMEI-21) preoperatively, 3 and 12 months postoperatively with regard to surgical technique and intraoperative staging of the cholesteatoma (ChOLE classification). Secondary outcomes included hearing pure tone average of 0.5, 1, 2 and 4 kHz (PTA₄), complications assessed 3 months postoperatively as well as recidivism within the follow-up time of 1 year postoperatively.

Results: A total of 28 patients underwent TEES and 160 microscopic ear surgery. The ZCMEI-21 total scores preoperatively were not significantly different between the two groups. An improvement in QoL one year postoperatively was observed in both groups to a comparable extent. The ZCMEI-21 decreased significantly (p < 0.01) in both groups. In the TEES group, the cholesteatoma tended to be smaller (lower ChOLE score), PTA₄ was better and complication rate comparable. The number of recidivisms was lower for the TEES group (1 [3.6%] vs. 31 [19.4%]).

Conclusion: TEES is a valuable alternative to the traditional microscopic technique, at least for small cholesteatoma, which leads to a comparable improvement in HRQoL as the microscopic technique. The better postoperative hearing and lower rate of recidivism in the TEES group may be related to the smaller extent of the cholesteatoma.