Nair Satish, Aishwarya J G, Vasu Pooja K, Karthikeyan Aditya, Shalini Martina
Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India.
M S Ramaiah Medical College, Bangalore, Karnataka India.
Indian J Otolaryngol Head Neck Surg. 2022 Dec;74(Suppl 3):4200-4211. doi: 10.1007/s12070-021-02869-2. Epub 2021 Oct 11.
Endoscopes have revolutionized the field of otology for the past two decades due to its minimally invasive technique and improved visualization. The advantage of endoscope during surgery for middle ear cholesteatoma both for diagnosing and aiding in removal of residual disease from the hidden areas and the resulting lower recurrence rates have been proven in the past by many authors. But the feasibility of totally endoscopic ear surgery and its surgical and patient related outcomes are yet to be explored in detail. We conducted this systematic review and meta-analysis to compare the surgical and patient related outcomes between totally endoscopic and microscopic technique in cases of acquired middle ear cholesteatoma. This meta-analysis has been conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Search engines used to identify the eligible articles were Pubmed, Web of Science, Cochrane Library, Virtual Health Library databases. The studies that compared the outcomes of microscopic and endoscopic techniques in case of acquired middle ear cholesteatoma and with more than 10 patients were included. Outcomes like recurrence, residual disease, graft uptake rate, audiological outcome, conversion rate, pain score, surgery duration, complications and quality of life outcomes were compared.The quality of the included studies was assessed by Methodological Index for Non-randomized studies criteria in case of non-randomized studies and by means of Cochrane Risk of Bias Tool in case of randomized controlled studies. A random effects model was used to calculate pooled estimates. The ODDS ratio and 95% confidence interval were calculated. The heterogeneity among the studies was represented by the Q statistic and Higgins I statistic. The test for overall effect was calculated by Z test and a p value of < 0.05 was considered as statistically significant. 11 studies were included in this meta-analysis. Out of 11 included studies, 4 were prospectively designed and 7 were retrospective studies. The overall effect showed recurrence rate (Z:2.69, P:0.007) was lower among endoscopic technique. Post-operative pain was less among the endoscopic technique and there was no difference between the groups with respect to surgical duration. Although endoscopic technique showed lower residual rate and post-operative vertigo with better graft success rate among the individual studies, the overall analysis showed that the difference was not statistically significant. Endoscope has been an invaluable tool in the cholesteatoma surgery over the past 20 years due to its excellent optics and minimally invasive technique. Evaluation of the present data available in the literature reveals that both the techniques have similar outcomes except for a definite advantage of endoscopic technique in reducing the recurrence and post-operative discomfort.
在过去二十年中，由于其微创技术和更好的可视化效果，内窥镜彻底改变了耳科学领域。过去许多作者已经证明，内窥镜在中耳胆脂瘤手术中，对于诊断以及辅助清除隐蔽区域的残留疾病具有优势，并且由此导致较低的复发率。但是，全内窥镜耳手术的可行性及其手术和患者相关的结果仍有待详细探讨。我们进行了这项系统评价和荟萃分析，以比较后天性中耳胆脂瘤病例中全内窥镜技术和显微镜技术在手术及患者相关结果方面的差异。本荟萃分析是按照系统评价和荟萃分析的首选报告项目指南进行的。用于识别符合条件文章的搜索引擎有PubMed、科学网、Cochrane图书馆、虚拟健康图书馆数据库。纳入了比较后天性中耳胆脂瘤病例中显微镜技术和内窥镜技术结果且患者超过10例的研究。比较了复发、残留疾病、移植物吸收率、听力结果、转换率、疼痛评分、手术时长、并发症和生活质量结果等指标。对于非随机研究，采用非随机研究方法学指标标准评估纳入研究的质量；对于随机对照研究，则采用Cochrane偏倚风险工具进行评估。使用随机效应模型计算合并估计值。计算比值比和95%置信区间。研究之间的异质性用Q统计量和Higgins I统计量表示。通过Z检验计算总体效应检验，p值<0.05被认为具有统计学意义。本荟萃分析纳入了11项研究。在纳入的11项研究中，4项为前瞻性设计，7项为回顾性研究。总体效应显示，内窥镜技术组的复发率较低（Z：2.69，P：0.007）。内窥镜技术组术后疼痛较轻，两组在手术时长方面无差异。尽管在个别研究中，内窥镜技术显示出较低的残留率和术后眩晕率，移植物成功率更高，但总体分析表明差异无统计学意义。在过去20年中，由于其出色的光学性能和微创技术，内窥镜一直是胆脂瘤手术中非常有价值的工具。对现有文献数据的评估表明，除了内窥镜技术在降低复发率和术后不适方面具有明显优势外，两种技术的结果相似。
