Quality of Life Outcomes After Endoscopic Cholesteatoma Surgery: A Prospective Cohort Study

Background: Cholesteatoma is a destructive middle ear lesion that compromises hearing and quality of life, for which endoscopic ear surgery (EES) has emerged as a minimally invasive alternative to microscopic approaches. While recurrence and audiological outcomes are frequently reported, patient-centered evaluations using validated patient-reported outcome measures (PROMs) remain limited. Objective: This study aimed to assess postoperative quality of life in patients undergoing exclusive endoscopic cholesteatoma surgery, using validated patient-reported outcome measures. Methods: We conducted a prospective observational cohort study in a tertiary referral center, enrolling 41 patients who underwent exclusive endoscopic cholesteatoma surgery over 20 months. Pre- and postoperative QoL was assessed using the Chronic Otitis Media Questionnaire-12 (COMQ-12) and the Glasgow Benefit Inventory (GBI). Follow-up included assessments at 3, 6, and 12 months, complemented by non–echo–planar diffusion-weighted magnetic resonance imaging (DWI-MRI) to detect residual or recurrent disease. Results: COMQ-12 scores improved significantly from baseline (54.0 ± 4.2) to 12 months (10.2 ± 3.3; mean difference –43.8, 95% CI: –46.1 to –41.5; p < 0.001). GBI scores were consistently high, increasing from 82.6 ± 4.8 at 6 months to 84.1 ± 4.9 at 12 months (p < 0.001). Audiometric evaluation demonstrated a significant postoperative improvement, with the mean air–bone gap (ABG) decreasing from 52.1 ± 5.3 dB pre-operatively to 26.4 ± 4.7 dB postoperatively (p < 0.001), indicating substantial closure of the conductive gap. Conclusions: Exclusive endoscopic cholesteatoma surgery is associated with significant improvement in disease-specific and general QoL, favorable audiological outcomes, and low recurrence rates. These findings support EES as a safe, effective, and patient-centered alternative to microscopic techniques for the management of middle ear cholesteatoma.