Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Seoul, South Korea.
Otolaryngol Head Neck Surg. 2022 Feb;166(2):249-259. doi: 10.1177/01945998211012300. Epub 2021 Jun 1.
We investigated the incidence of tympanic membrane (TM) perforations induced after intratympanic steroid injection (ITSI) in patients with sudden sensorineural hearing loss (SSNHL) through a systematic review and meta-analysis.
PubMed, Embase, and MEDLINE.
Primary database searches were performed, and 1901 records were identified. After removal of 1802 articles through abstract screening, the remaining 99 full-text journals were assessed for eligibility to be included in the study. Fifty-eight studies that used either ventilation tubing (VT) or tympanocentesis (TC) for ITSI were selected for analysis. The subjects were divided into VT and TC groups. The rate of TM perforation after ITSI in 2 groups, sites of ITSI, needle gauge, and influence on residual hearing were investigated.
The cohorts comprised patients who underwent VT (n = 257, 9.6%) and TC (n = 2415, 90.4%). The proportion of TM perforation after ITSI in each group was 0.073 (95% CI, 0.0469-0.1113) and 0.010 (95% CI, 0.0045-0.0215), respectively, which suggested that the VT group showed a significantly higher TM perforation rate than the TC group ( < .001). In the subgroup analyses, there was no significant difference in the odds ratio for the rate of TM perforation according to the injection site and needle gauge for TC. The proportion of surgical repair showed no significant difference between the 2 groups.
ITSI via VT may have a significantly higher risk of TM perforation than ITSI via TC, although those are relatively small overall. ITSI should be performed in the direction to minimize possible adverse effects.
通过系统评价和荟萃分析，调查鼓室类固醇注射（ITSI）后引起的鼓膜穿孔（TM）的发生率在突发性聋（SSNHL）患者中。
PubMed、Embase 和 MEDLINE。
进行了初步数据库检索，确定了 1901 条记录。通过摘要筛选去除 1802 篇文章后，评估了 99 篇全文期刊的纳入研究资格。选择了 58 项使用鼓室通气管（VT）或鼓室穿刺（TC）进行 ITSI 的研究进行分析。将受试者分为 VT 和 TC 组。研究了 2 组 ITIS 后 TM 穿孔率、ITSI 部位、针规以及对残余听力的影响。
该队列包括接受 VT（n = 257，9.6%）和 TC（n = 2415，90.4%）的患者。每组 ITIS 后 TM 穿孔的比例分别为 0.073（95%CI，0.0469-0.1113）和 0.010（95%CI，0.0045-0.0215），表明 VT 组的 TM 穿孔率明显高于 TC 组（<.001）。在亚组分析中，根据 TC 的注射部位和针规，TM 穿孔率的比值比没有显著差异。两组手术修复的比例没有显著差异。
与 TC 相比，通过 VT 进行 ITSI 可能会导致 TM 穿孔的风险显著增加，尽管总体风险相对较小。ITSI 应在最小化可能的不良反应的方向上进行。
