Predicting residual cholesteatoma with the Potsic staging system still lacks evidence: a systematic review and meta-analysis

Abstract

Purpose: To investigate the rate of residual disease in the Potsic staging system for congenital cholesteatomas.

Methods: A protocol registration was published on PROSPERO (CRD42022383932), describing residual disease as a primary outcome and hearing improvement as secondary. A systematic search was performed in four databases (PubMed, Embase, Cochrane Library, Web of Science) on December 14, 2022. Articles were included if cholesteatomas were staged according to the Potsic system and follow-up duration was documented. Risk of bias was evaluated using the Quality In Prognosis Studies (QUIPS) tool. In the statistical synthesis a random effects model was used. Between-study heterogeneity was assessed using I².

Results: Thirteen articles were found to be eligible for systematic review and seven were included in the meta-analysis section. All records were retrospective cohort studies with high risk of bias. Regarding the proportions of residual disease, analysis using the χ² test showed no statistically significant difference between Potsic stages after a follow-up of minimum one year (stage I 0.06 (confidence interval (CI) 0.01-0.33); stage II 0.20 (CI 0.09-0.38); stage III 0.06 (CI 0.00-0.61); stage IV: 0.17 (CI 0.01-0.81)). Postoperative and preoperative hearing outcomes could not be analyzed due to varied reporting. Results on cholesteatoma location and mean age at staging were consistent with those previously published.

Conclusion: No statistically significant difference was found in the proportions of residual disease between Potsic stages, thus the staging system's applicability for outcome prediction could not be proven based on the available data. Targeted studies are needed for a higher level of evidence.

Keywords: Congenital cholesteatoma; Potsic; Residual cholesteatoma.

Fig. 1

PRISMA flowchart of the selection process, which started with 6,616 articles and included 13 articles included in the review and 7 included in the meta-analysis section

Fig. 2

Forest plot showing the proportion of residual disease from the total number of patients after 1 year in four stages of the Potsic staging system for congenital cholesteatoma

Fig. 3

Bar chart depicting the quadrants of the tympanic membrane cholesteatomas are most commonly visible through in each stage as documented in the key articles 20, 22–26, 28, 29

Fig. 4

Mean age (years) at staging for patients diagnosed with congenital cholesteatoma in our key articles