Impact of surgical approach on taste dysfunction and quality of life in middle ear surgery: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis evaluated how middle ear surgical approach and chorda tympani nerve (CTN) handling influence postoperative taste disturbance and related quality of life.

METHODS

Following PRISMA 2020 guidance, databases and grey literature were searched (2000-2025) for randomized and observational studies reporting taste outcomes after tympanoplasty, stapes surgery, cholesteatoma/mastoidectomy, or cochlear implantation. Risk of bias was assessed with RoB 2.0 and Newcastle-Ottawa scales, and certainty with GRADE. CTN manipulation was standardised using a four-level CTN Handling Severity Index (CHSI 0-3).

RESULTS

20 studies were included. Pooled analyses suggested endoscopic approaches substantially reduced early taste disturbance compared with microscopic techniques (pooled RR ≈ 0.45), while CHSI 0-1 handling conferred markedly lower risk than CTN transection (pooled RR ≈ 0.18). Time-stratified curves showed overall disturbance falling from about 40-45% immediately post-surgery to 5-10% beyond 12 months, with slower and incomplete recovery in CHSI 2-3 injuries. Persistent symptoms were associated with measurable decrements in patient-reported oral satisfaction and HRQoL.

CONCLUSION

Surgical approach and CTN handling strongly determine the incidence, severity and persistence of taste dysfunction after middle ear surgery. The CHSI and time-based recovery model provide practical tools for nerve-sparing planning and patient counselling.