Underlay Myringoplasty Versus Overlay Myringoplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

覆盖膜鼓膜成形术与覆盖膜鼓膜成形术 ： 随机对照试验的系统评价和荟萃分析。

• 发表时间: 2024 Apr
• 来源期刊: Indian J Otolaryngol Head Neck Surg
• DOI: 10.1007/s12070-023-04425-6
• PMID: 38566745
• 文章类型: Journal Article
• 作者列表: Albazee E,Salamah M,Althaidy M,Hagr A

关键词: Myringoplasty; Overlay; Surgical Success rate; Tympanoplasty; Underlay

Abstract

Myringoplasty is still the most performed otological surgery. Nevertheless, the underlay vs. overlay approaches have yet to be determined. The purpose of this study is to compare the surgical and audiological outcomes of underlay and overlay myringoplasty in perforated tympanic membrane patients. A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching of Web of Science, SCOPUS, PubMed, and Google Scholar until January 25th, 2023. RevMan version 5.4 software was used to pooled dichotomous outcomes using the risk ratio (RR) with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: [CRD42023387432]. We included eight RCTs with 656 tympanic perforation membrane patients. Four RCTs had a low risk of overall bias, two had some concerns, and two had a high risk of bias. The underlay technique was significantly associated with a higher surgical success rate (n = 7 RCTs, RR: 1.21 with 95% CI [1.02, 1.43],  P = 0.03) and audiological success rate (n = 4 RCTs, RR: 1.31 with 95% CI [1.18, 1.44], P < 0.00001). This meta-analysis underscores the potential superiority of the underlay technique in managing tympanic membrane perforations, with significant implications for surgical and audiological outcomes. However, more investigations are still necessary to confirm this result.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s12070-023-04425-6.

摘要

鼓膜成形术仍然是进行最多的耳科手术。然而，底层与覆盖方法尚未确定。这项研究的目的是比较鼓膜穿孔患者的下层和覆盖膜成形术的手术和听力学结果。综合随机对照试验(RCTs)的系统评价和荟萃分析，通过系统地搜索WebofScience，Scopus,PubMed,和谷歌学者直到1月25日，2023年。RevMan5.4版软件用于使用风险比（RR）和相应的95％置信区间（CI）合并二分结果。我们在PROSPERO中注册了我们的协议，ID为[CRD42023387432]。我们纳入了8个RCT，其中656名鼓膜穿孔患者。四个随机对照试验的总体偏倚风险较低，两个人有些担心，两个有很高的偏见风险。底层技术与较高的手术成功率显着相关（n=7，RR：1.21，95%CI[1.02，1.43]，P=0.03）和听力学成功率（n=4个随机对照试验，RR：1.31，95%CI[1.18，1.44]，P<0.00001)。这项荟萃分析强调了底层技术在管理鼓膜穿孔方面的潜在优势，对手术和听力学结果有重大影响。然而,仍需要更多的调查来证实这一结果。
■在线版本包含补充材料，可在10.1007/s12070-023-04425-6获得。