目的:目的是研究活动性中耳炎对慢性中耳炎(COM)和鼓膜穿孔患者鼓室成形术成功率的影响。
■PubMed,Embase和Cochrane图书馆。
方法:纳入标准是对任何年龄的COM患者因COM引起鼓膜穿孔而进行鼓室成形术的闭合率的研究。排除标准是对同时进行乳突切除术的患者的研究,听骨链重建,输卵管成形术,腺样体切除术,翻修鼓室成形术,由于COM以外的其他条件而导致穿孔的患者,和给编辑的信,评论,会议摘要和案例报告。使用QUIPS工具对所包含的文章进行了严格评估。提取鼓膜闭合率数据,计算湿耳与干耳的闭合率的比值比(OR)和95%置信区间(CI).
结果:搜索于2023年2月1日进行。在4671篇文章中,纳入了16项研究,并对其进行了严格评估。在这些观察性研究中(九项前瞻性研究,七个回顾性),共1509例患者(干耳组n=1003;湿耳组n=506),两项研究表明成功率有显著差异,一个赞成干燥的耳朵,一个赞成在手术时湿润的耳朵。所有其他研究均未显示统计学上的显着差异。总的来说,偏倚风险被认为是中等至高.
结论:我们发现鼓室成形术期间活动性中耳炎对鼓膜闭合率无显著预后价值。因为总体偏倚风险被认为是中等到高的,无法得出强有力的结论。为了能够用更高水平的证据来回答这个问题,需要高质量的前瞻性或随机研究.
OBJECTIVE: 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.
UNASSIGNED: PubMed, Embase and the Cochrane Library.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.