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Scientific Oral Presentation

Otology/Neurotology

Surgical Considerations in Facial Palsy Secondary to Cholesteatoma: A Systematic Review and Meta-analysis

Monday, October 19, 2026
10:12 AM - 10:18 AM PT
Location: West Exhibit Hall A, Learning Zone 2

    Presenting Author(s)

  • DM

    Danielle Metzbower, MD

    Resident Physician
    Department of Otolaryngology - Head & Neck Surgery, University of Virginia
    Charlottesville, Virginia, United States

    • Senior Author(s)

  • BL

    Benjamin D. Lovin, MD

    Assistant Professor
    Department of Otolaryngology - Head & Neck Surgery, University of Virginia
    Charlottesville, VA, United States

    • Co-Author(s)

  • Bao Y. Sciscent, MD

    Resident Physician
    Department of Otolaryngology-Head & Neck Surgery, University of Virginia
    Charlottesville, VA, United States

  • AB

    Anushka Biswas, N/A

    Medical Student
    University of Virginia, United States

Disclosure(s):
Benjamin D. Lovin, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Bao Y. Sciscent, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: New onset facial palsy in patients with cholesteatoma is ominous, and anticipated benefit and optimal timing of surgery is unclear. This systematic review and meta-analysis reviews the presentation and treatment of such patients and examines how the approach and timing of surgery can impact facial nerve prognosis.

Methods: The PubMed, Embase, OVID Medline, and CINAHL databases were searched using PRISMA guidelines to conduct a systematic review and meta-analysis to investigate patients with cholesteatoma presenting with facial palsy who subsequently underwent surgery. Outcomes included House-Brackmann (HB) score pre- and post-surgery, timing of palsy onset to intervention, segment of facial nerve involved, and type of surgery.

Results: A total of 576 unique studies were identified, of which 10 studies (n=161) met inclusion criteria. Six studies allowed for pooled analysis (n=63). The mean duration from presentation to last follow-up was 57 months. The average pre-operative HB score was 3.78, with 13% having HB I or II and 27% having HB V or VI. The median time from facial palsy onset to surgery was 7 days (range, 2-548 days). The most common surgery was canal wall down tympanomastoidectomy in 65%. The tympanic segment was most often involved by cholesteatoma at 49%, then mastoid segment at 9%. 27% involved tympanic and mastoid segments while 15% involved tympanic and labyrinthine segments. Overall, 94% of patients had some degree of improvement post-operatively. The average post-operative HB score was 1.75, with 79% having HB I or II and 5% having HB V or VI. The summarized proportion of all patients that recovered to HB I or II was 75% (CI 0.67 - 0.83), per random effects. On linear regression, a 1 unit increase in pre-operative HB score corresponded to a 0.53 unit increase in post-operative HB score, and each additional day to surgery corresponded to a 0.02 unit increase in post-operative HB score.

Conclusions: Patients with cholesteatoma presenting with facial palsy appear to display recovery with surgery, most notably in those with less severe pre-operative palsy and when surgery is performed sooner after palsy onset.