Faculty of Medicine, University of Utrecht, Utrecht, The Netherlands.
Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Clin Otolaryngol. 2024 Nov;49(6):699-712. doi: 10.1111/coa.14205. Epub 2024 Jul 30.
The aim is to investigate the influence of an active otitis media on the success rate of tympanoplasty in patients with a chronic otitis media (COM) and a tympanic membrane perforation.
PubMed, Embase and the Cochrane Library.
The inclusion criteria were studies on closure rates of tympanoplasty performed in COM patients of any age with a tympanic membrane perforation caused by COM. The exclusion criteria were studies on patients undergoing concomitant mastoidectomy, ossicular chain reconstruction, tuboplasty, adenoidectomy, revision tympanoplasty, patients with perforations due to other conditions than COM, and letters to editors, commentaries, conference abstracts and case reports. The included articles were critically appraised using the QUIPS tool. Data on tympanic membrane closure rate were extracted, odds ratio (OR) and 95% confidence intervals (CI) of the closure rate with a wet versus a dry ear were calculated.
The search was performed on 1 February 2023. Of 4671 articles, 16 studies were included and critically appraised. Of these observational studies (nine prospective, seven retrospective), with a total of 1509 patients (dry ear group n = 1003; wet ear group n = 506), two studies stated a significant difference in success rate, one in favour of a dry ear and one in favour of a wet ear at time of surgery. All other studies did not show a statistically significant difference. Overall, the risk of bias was considered moderate to high.
We found no significant prognostic value of having an active otitis media during tympanoplasty on tympanic membrane closure rates. Because the overall risk of bias was considered moderate to high, no strong conclusions can be made. To be able to answer this question with higher levels of evidence, high-quality prospective or randomized studies are needed.
本研究旨在探讨中耳积极炎症对慢性中耳炎（COM）伴鼓膜穿孔患者鼓室成形术成功率的影响。
PubMed、Embase 和 Cochrane 图书馆。
纳入标准为任何年龄的 COM 患者伴由 COM 引起的鼓膜穿孔行鼓室成形术的闭合率研究。排除标准为同时行乳突切除术、听骨链重建术、鼓室成形术、腺样体切除术、翻修鼓室成形术、穿孔原因非 COM 的患者，以及信件、评论、会议摘要和病例报告。使用 QUIPS 工具对纳入的文章进行批判性评估。提取鼓膜闭合率数据，计算干耳与湿耳的鼓膜闭合率的比值比（OR）和 95%置信区间（CI）。
检索于 2023 年 2 月 1 日进行。在 4671 篇文章中，纳入并批判性评估了 16 项研究。这些观察性研究（9 项前瞻性，7 项回顾性）共纳入了 1509 名患者（干耳组 n=1003；湿耳组 n=506），其中两项研究表明手术时鼓膜闭合率有显著差异，一项有利于干耳，一项有利于湿耳。其余所有研究均未显示出统计学差异。总体而言，偏倚风险被认为是中度到高度。
我们发现中耳积极炎症对鼓室成形术时鼓膜闭合率无显著预后价值。由于总体偏倚风险被认为是中度到高度，因此无法得出明确的结论。为了能够用更高水平的证据回答这个问题，需要高质量的前瞻性或随机研究。
