Trinidade Aaron, Page Joshua C, Dornhoffer John L
University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Otolaryngol Head Neck Surg. 2016 Dec;155(6):914-922. doi: 10.1177/0194599816662438. Epub 2016 Aug 2.
Despite evidence that therapeutic mastoidectomy does not improve outcomes in noncholesteatomatous chronic otitis media, it remains widely performed. An up-to-date systematic review is undertaken and conclusions drawn regarding the best evidence-based practice of its management.
PubMed, Google Scholar, Medline Embase, Cochrane, and Web of Science.
A combination of the following words was used: chronic otitis media, chronic suppurative otitis media, COM, CSOM, mastoidectomy, tympanoplasty, atelectasis, retraction, tympanic perforation, and therapeutic.
From 1742 studies, 7 were selected for full analysis with respect to the benefit of mastoidectomy in the management of active and inactive mucosal chronic otitis media. Most were retrospective studies, with 1 prospective randomized controlled trial available. Overall, there was no evidence to support routine mastoidectomy in conjunction with tympanoplasty in chronic otitis media. For ears with sclerotic mastoids, the evidence suggested that there may be some benefit as a staged procedure. Two studies were analyzed for the benefit of mastoidectomy in addition to tympanoplasty for the management of the atelectatic ear (inactive squamous chronic otitis media). The conclusion was also that mastoidectomy added no benefit.
Examination of the available literature supports the notion that therapeutic mastoidectomy does not lend any additional benefit to the management of noncholesteatomatous chronic otitis media. This has implications for patient care, both clinically and financially. Further research, ideally in the form of a prospective, multi-institutional, geographically wide, ethnically diverse, randomized controlled trial, is needed to further support this notion.
尽管有证据表明治疗性乳突切除术并不能改善非胆脂瘤性慢性中耳炎的治疗效果，但该手术仍被广泛实施。本文进行了一项最新的系统综述，并就其基于最佳证据的管理实践得出结论。
PubMed、谷歌学术、Medline Embase、Cochrane和科学网。
使用了以下词语的组合：慢性中耳炎、慢性化脓性中耳炎、COM、CSOM、乳突切除术、鼓室成形术、肺不张、内陷、鼓膜穿孔和治疗性。
从1742项研究中，选取了7项进行全面分析，以探讨乳突切除术在活动性和非活动性黏膜慢性中耳炎管理中的益处。大多数是回顾性研究，仅有1项前瞻性随机对照试验。总体而言，没有证据支持在慢性中耳炎中常规联合乳突切除术和鼓室成形术。对于乳突硬化的耳朵，证据表明分期手术可能有一些益处。分析了2项关于除鼓室成形术外，乳突切除术对肺不张耳（非活动性鳞状慢性中耳炎）管理益处的研究。结论也是乳突切除术没有增加益处。
对现有文献的审查支持了这样一种观点，即治疗性乳突切除术对非胆脂瘤性慢性中耳炎的管理没有任何额外益处。这在临床和经济方面对患者护理都有影响。需要进一步的研究，理想形式是前瞻性、多机构、地域广泛、种族多样的随机对照试验，以进一步支持这一观点。
