Kamalski Digna M A, Wegner Inge, Tange Rinze A, Vincent Robert, Stegeman Inge, van der Heijden Geert J M, Grolman Wilko
*Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht; †Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; ‡Jean Causse Ear Clinic, Traverse de Béziers, Colombiers, France; §Department of Epidemiology, Julius Center, University Medical Center Utrecht; and ∥Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, The Netherlands.
Otol Neurotol. 2014 Jul;35(6):1046-51. doi: 10.1097/MAO.0000000000000270.
To assess hearing results and complications following primary stapedotomy in otosclerosis patients, comparing different laser types.
Pubmed, Embase, The Cochrane Library, CINAHL, and Scopus.
A systematic bibliographic search was conducted to identify all original articles, comparing hearing outcome between different lasers used for fenestration in stapedotomy.
Directness of evidence and risk of bias of the selected articles were assessed. Studies with low or moderate directness of evidence, or high risk of bias, were not further analyzed.
The absolute risks, risk differences, and 95% confidence intervals were extracted only for the studies with high directness of evidence and moderate to low risk of bias.
A total of 383 unique articles were retrieved. Four studies provided direct evidence, whereas all studies carried moderate to high risk of bias. After exclusion of the studies that did not provide direct evidence and/or carried high risk of bias, 2 studies were considered eligible for data extraction. This best available evidence shows a slightly better air-bone gap closure for CO2 laser compared to potassium titanyl phosphate laser, but the clinical relevance is unclear. The risk difference of 28.1% [95% confidence interval, 22.8, 33.4] between CO2 and erbium yttrium aluminium garnet favors CO2 laser. Unfortunately, this current best available evidence is insufficient to draw any definitive conclusions on which laser to use for fenestration in stapedotomy.
评估耳硬化症患者初次镫骨切除术的听力结果及并发症，比较不同类型的激光。
PubMed、Embase、Cochrane图书馆、CINAHL和Scopus。
进行系统的文献检索以识别所有原始文章，比较镫骨切除术中用于开窗的不同激光之间的听力结果。
评估所选文章的证据直接性和偏倚风险。证据直接性低或中等或偏倚风险高的研究不再进一步分析。
仅从证据直接性高且偏倚风险为中到低的研究中提取绝对风险、风险差异和95%置信区间。
共检索到383篇独特文章。四项研究提供了直接证据，但所有研究均存在中到高的偏倚风险。排除未提供直接证据和/或偏倚风险高的研究后，两项研究被认为符合数据提取条件。现有最佳证据表明，与磷酸钛氧钾激光相比，二氧化碳激光的气骨导差闭合效果略好，但临床相关性尚不清楚。二氧化碳激光与铒钇铝石榴石激光之间28.1%[95%置信区间，22.8，33.4]的风险差异支持二氧化碳激光。不幸的是，目前的最佳证据不足以就镫骨切除术中开窗使用哪种激光得出任何明确结论。
