Hardman John, Muzaffar Jameel, Nankivell Paul, Coulson Chris
*Department of Otolaryngology Head and Neck Surgery, University Hospital Coventry and Warwickshire, Coventry; †Department of Otolaryngology Head and Neck Surgery, Birmingham City Hospital, Birmingham; and ‡Department of Otolaryngology Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, U.K.
Otol Neurotol. 2015 Jun;36(5):796-804. doi: 10.1097/MAO.0000000000000767.
To study the effectiveness of Type 1 tympanoplasty for chronic tympanic membrane perforations in the pediatric age group and to investigate factors influencing its success.
Searches were conducted of the MEDLINE database and the Cochrane Database of Systematic Reviews using terms focused around tympanoplasty and children. Searches were performed on June 23, 2014 and limited to English language entries since January 1, 1997.
Studies reporting tympanoplasty closure rates in children 18 years and younger, with a minimum follow-up of 6 months, were included. Studies focusing on more advanced forms of tympanoplasty and revision surgery were excluded.
Five hundred sixty-four articles were screened identifying 2,609 cases from 45 eligible studies. Data were collected by consensus of the first two authors with the third author arbitrating disparities of opinion. Success was taken as the closure rate at 12 months where possible.
Forest plots with Mantel-Haenszel analyses were used to compare closure rates with respect to perforation size, adenoidectomy, status of contralateral ear, Eustachian tube function, active infection, and graft position. Linear regression and Fisher's exact were used to analyze closure rate with respect to age.
The mean weighted closure rate for pediatric tympanoplasty was 83.4%. Subgroup analysis found age not to be a significant factor affecting the closure rate. Tympanoplasties performed on larger perforations or in children with abnormal contralateral ear findings were more likely to fail. Surgery may be best delayed until contralateral otitis media with effusion has settled.
研究Ⅰ型鼓室成形术治疗小儿慢性鼓膜穿孔的有效性，并探讨影响其成功的因素。
使用围绕鼓室成形术和儿童的检索词，对MEDLINE数据库和Cochrane系统评价数据库进行检索。检索于2014年6月23日进行，限于1997年1月1日以来的英文文献条目。
纳入报告18岁及以下儿童鼓室成形术闭合率且随访至少6个月的研究。排除关注更高级形式鼓室成形术和翻修手术的研究。
筛选了564篇文章，从45项符合条件的研究中确定了2609例病例。由前两位作者达成共识收集数据，第三位作者仲裁意见分歧。成功定义为尽可能在12个月时的闭合率。
使用带有Mantel-Haenszel分析的森林图比较穿孔大小、腺样体切除术、对侧耳状况、咽鼓管功能、活动性感染和移植物位置方面的闭合率。使用线性回归和Fisher精确检验分析年龄与闭合率的关系。
小儿鼓室成形术的平均加权闭合率为83.4%。亚组分析发现年龄不是影响闭合率的显著因素。在较大穿孔患儿或对侧耳检查结果异常的患儿中进行的鼓室成形术更有可能失败。手术最好推迟到对侧中耳积液消退后进行。
