Ossen Mira E, Stokroos Robert, Kingma Herman, van Tongeren Joost, Van Rompaey Vincent, Temel Yasin, van de Berg Raymond
Faculty of Medicine, Maastricht University, Maastricht, Netherlands.
Department of Otorhinolaryngology and Head & Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.
Front Neurol. 2017 Jul 24;8:347. doi: 10.3389/fneur.2017.00347. eCollection 2017.
Superior canal dehiscence syndrome (SCDS) can be treated surgically in patients with incapacitating symptoms. However, the ideal treatment has not been determined.
This systematic literature review aims to assess available evidence on the comparative effectiveness and risks of different surgical treatments regarding: (1) symptom improvement; (2) objectively measurable auditory and vestibular function; (3) adverse effects, and (4) length of hospitalization.
A systematic database search according to PRISMA statement was conducted on Pubmed, Embase, and Cochrane library. In addition, reference lists were searched. No correspondence with the authors was established. The last search was conducted on June 9, 2017.
Retrospective and prospective cohort studies were held applicable under the condition that they investigated the association between a surgical treatment method and the relief of vestibular and/or auditory symptoms. Only studies including quantitative assessment of the pre- to postoperative success rate of a surgical treatment method were included. Case reports, reviews, meta-analysis, and studies not published in English, Dutch, or German were excluded.
The first author searched literature and extracted data; the first and last analyzed the data.
Seventeen studies (354 participants, 367 dehiscences) met the eligibility criteria and were grouped according to surgical approach. Seven combinations of surgical approaches and methods for addressing the dehiscence were identified: plugging, resurfacing, or a combination of both through the middle fossa (middle fossa approach); plugging, resurfacing, or a combination of both through the mastoid (transmastoid approach); round window reinforcement through the ear canal (transcanal approach). Several studies showed high internal validity, but quality was often downgraded due to study design (1). Outcome measures and timing of postsurgical assessment varied among studies, making it unfeasible to pool data to perform a meta-analysis.
A standardized protocol including outcome measures and timeframes is needed to compare the effectiveness and safety SCDS treatments. It should include symptom severity assessments and changes in vestibular and auditory function before and after treatment.
上半规管裂综合征（SCDS）患者若症状严重，可采用手术治疗。然而，理想的治疗方法尚未确定。
本系统文献综述旨在评估不同手术治疗在以下方面的比较有效性和风险的现有证据：（1）症状改善情况；（2）客观可测量的听觉和前庭功能；（3）不良反应；（4）住院时间。
根据PRISMA声明，在PubMed、Embase和Cochrane图书馆进行了系统的数据库检索。此外，还检索了参考文献列表。未与作者进行通信。最后一次检索于2017年6月9日进行。
回顾性和前瞻性队列研究在调查手术治疗方法与前庭和/或听觉症状缓解之间的关联时适用。仅纳入了对手术治疗方法术前至术后成功率进行定量评估的研究。排除病例报告、综述、荟萃分析以及未以英语、荷兰语或德语发表的研究。
第一作者检索文献并提取数据；第一作者和最后作者分析数据。
17项研究（354名参与者，367处骨裂）符合纳入标准，并根据手术入路进行分组。确定了7种手术入路和处理骨裂方法的组合：通过中颅窝进行填塞、表面重建或两者结合（中颅窝入路）；通过乳突进行填塞、表面重建或两者结合（经乳突入路）；通过耳道进行圆窗强化（经耳道入路）。多项研究显示内部效度较高，但由于研究设计，质量常被降级（1）。研究之间的结果测量和术后评估时间各不相同，因此无法汇总数据进行荟萃分析。
需要一个包括结果测量和时间框架的标准化方案，以比较SCDS治疗的有效性和安全性。该方案应包括症状严重程度评估以及治疗前后前庭和听觉功能的变化。
