The Global Burden of Cholesteatoma: A Systematic Review and Meta-analysis.

Abstract

This systematic review and meta-analysis sought to estimate the global and World Health Organization (WHO) regional prevalence and burden of cholesteatoma. PubMed, APA PsycINFO, the Cochrane Library, Embase, and WHO International Clinical Trials Registry Platform (ICTRP) from 2010 to 2025. Teams of independent reviewers assessed each study for inclusion. Studies reporting primary data on cholesteatoma prevalence, recurrence, or its impact were included. The primary outcome was the global prevalence, whereas secondary outcomes were regional prevalence and recidivism rates, treatment, and complications. A random-effects meta-analysis was used to pool data, and study quality and publication bias were assessed. This study was registered with PROSPERO (CRD42024533132). Forty-six eligible studies were included in the meta-analysis. The pooled global prevalence of cholesteatoma was estimated at 4.02 per 1000 persons (95% CI 1.79-7.10). By the WHO regions, the pooled prevalence of cholesteatoma in the Western Pacific Region, European Region, South East Asian Region, Region of the Americas, and African Region was estimated at 5.73 per 1000 persons (95% CI 1.00-13.87), 2.32 per 1000 persons (95% CI 2.23-2.42), 3.30 per 1000 persons (95% CI 2.65-4.11), 0.06 per 1000 persons (95% CI 0.00-0.00), and 7.32 per 1000 persons (95% CI 2.77-13.96), respectively. The prevalence of hearing loss in cholesteatoma was estimated at 75.68 per 100 cases (95% CI 59.02-89.24). This meta-analysis is the first to systematically quantify global and regional cholesteatoma prevalence, complications, and treatment approaches, highlighting regional disparities and informing public health strategies and policy globally.