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Original Investigation
October 15, 2020

Subtotal Petrosectomy and Cochlear Implantation: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
JAMA Otolaryngol Head Neck Surg. Published online October 15, 2020. doi:10.1001/jamaoto.2020.3380
Key Points

Question  What are the indications for and complications of subtotal petrosectomy (STP) for cochlear implantation?

Findings  In this systematic review and meta-analysis with 27 unique studies and 397 unique STP procedures performed on 377 patients for cochlear implantation, the global complication rate was 12.4% and the cholesteatoma recidivism rate was 9.3%. The most common indications for STP included chronic otitis media, preexisting mastoid cavity, and cholesteatoma, and complication rates were not significantly different across single-stage vs multistage procedures, or in pediatric vs adult populations.

Meaning  This study’s findings suggest that STP is a safe and effective method in preparing the ear for cochlear implantation.


Importance  Subtotal petrosectomy (STP) has been more frequently performed to prepare ears with unfavorable conditions for cochlear implantation.

Objectives  To provide an overview of indications for and complications of STP and cochlear implantation and to compare outcomes between single vs multistage procedures and between pediatric vs adult populations.

Data Sources  A search of PubMed, Scopus, Ovid, and the Cochrane Library was performed from the databases’ inception to January 23, 2020, for studies evaluating STP for cochlear implantation.

Study Selection  Studies with a minimum follow-up of 3 months and no missing data regarding postoperative outcomes were included. Of the initial 570 studies identified, 27 (4.7%) met selection criteria.

Data Extraction and Synthesis  Two reviewers independently assessed study eligibility according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines; discrepancies were resolved by a third reviewer. Extracted data included patient demographics, indications for STP, rates of complications, and cholesteatoma recidivism when applicable. Data were pooled using a random- or a fixed-effects model when appropriate.

Main Outcomes and Measures  The primary study outcome was rate of global complications stratified by patient- and surgery-level characteristics.

Results  Twenty-seven unique studies with 377 unique patients (54.2% male; mean age, 50.6 [range, 1-99] years) undergoing 397 STP procedures and cochlear implantation were included. Of these procedures, 299 of 394 cases with the information reported (75.9%) were single procedures and 95 (24.1%) were multistage procedures. Of the total 397 STP procedures, most common indications included chronic otitis media (220 cases [55.4%]), previous open mastoid cavity (141 [35.5%]), cholesteatoma (74 [18.6%]), and cochlear ossification (29 [7.3%]). The overall complication rate was 12.4% (95% CI, 9.4%-15.9%); overall cholesteatoma recidivism rate was 9.3% (95% CI, 4.3%-17.1%). Complication rates did not significantly differ based on stage or age of patients. Cases with cholesteatoma more often underwent multistage vs single-stage procedures (23 of 54 [42.6%] vs 35 of 174 [20.1%]).

Conclusions and Relevance  Across all age groups, STP has been shown to be an effective surgical operation in preparing an ear with unfavorable conditions for cochlear implantation. The potential indications for which cochlear implantation can be performed have expanded with the use of STP. Presence of cholesteatoma might indicate that a multistage procedure should be performed. Lastly, with complication rates comparable to those in adult patients, STP can be considered in children requiring cochlear implantation to minimize ear-related issues and allow benefit from cochlear implantation.

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