José Faibes Lubianca Neto1,2,3,4, Artur Koerig Schuster5,6, Tales Antunes Fanzini7, João Pedro Neves Lubianca8, Lucas Rodrigues Mostardeiro5,6, Roland Douglas Eavey9. 1. Medical School of Federal, University of Health Sciences of Porto Alegre (UFCSPA), Rua Ciro Gavião 601, apt 195, Porto Alegre, RS, 90470-020, Brazil. jlubianca@ufcspa.edu.br. 2. Graduate Program in Pediatrics of UFCSPA, Porto Alegre, RS, Brazil. jlubianca@ufcspa.edu.br. 3. Otorhinolaryngology Service of Santa Casa de Misericórdia Hospital of Porto Alegre, Porto Alegre, RS, Brazil. jlubianca@ufcspa.edu.br. 4. Pediatric Otolaryngology Service of Santo Antonio Children's Hospital of Porto Alegre, Porto Alegre, RS, Brazil. jlubianca@ufcspa.edu.br. 5. Otorhinolaryngology Service of Santa Casa de Misericórdia Hospital of Porto Alegre, Porto Alegre, RS, Brazil. 6. Pediatric Otolaryngology Service of Santo Antonio Children's Hospital of Porto Alegre, Porto Alegre, RS, Brazil. 7. Medical School of Federal, University of Health Sciences of Porto Alegre (UFCSPA), Rua Ciro Gavião 601, apt 195, Porto Alegre, RS, 90470-020, Brazil. 8. Medical School of Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil. 9. Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Abstract
PURPOSE: The purpose of this study was to compare the effectiveness of endoscopic and microscopic approaches for butterfly cartilage graft inlay tympanoplasty regarding anatomical and hearing outcomes through a systematic review and meta-analysis. METHODS: A search of PubMed, Embase, MEDLINE, and Virtual Health Library was performed from inception to July 3rd, 2021, using keywords, such as tympanoplasty, cartilage graft, and inlay technique. Data from articles that met inclusion criteria were extracted by two authors independently. The PRISMA statement was followed. RoB-2 and ROBINS-I tools were used to assess risk of bias. The primary outcome was tympanic membrane closure rate. The secondary outcome was improvement of the air-bone gap. RESULTS: Five studies were included, one randomized clinical trial and four retrospective cohorts, in which a total of 318 patients were included. Graft take rate was 91.3% in the endoscopic group and 93.6% in the microscopic group (RR 0.98; 95% CI 0.93-1.03; I2 0%; P = 0.68). Four studies provided data about the secondary outcome, all showing significant reductions in air-bone gap, ranging from 5.7 to 11.0 in the endoscope group and from 5.8 to 11.6 in the microscope group, with a mean difference between groups of 0.85 (95% CI - 0.79 to 2.48). CONCLUSION: Although the overall evidence of the included studies was low, endoscopic and microscopic butterfly cartilage graft inlay tympanoplasties have similar results on anatomical and hearing outcomes, making the selection between such approaches an individual choice for the surgeon.
PURPOSE: The purpose of this study was to compare the effectiveness of endoscopic and microscopic approaches for butterfly cartilage graft inlay tympanoplasty regarding anatomical and hearing outcomes through a systematic review and meta-analysis. METHODS: A search of PubMed, Embase, MEDLINE, and Virtual Health Library was performed from inception to July 3rd, 2021, using keywords, such as tympanoplasty, cartilage graft, and inlay technique. Data from articles that met inclusion criteria were extracted by two authors independently. The PRISMA statement was followed. RoB-2 and ROBINS-I tools were used to assess risk of bias. The primary outcome was tympanic membrane closure rate. The secondary outcome was improvement of the air-bone gap. RESULTS: Five studies were included, one randomized clinical trial and four retrospective cohorts, in which a total of 318 patients were included. Graft take rate was 91.3% in the endoscopic group and 93.6% in the microscopic group (RR 0.98; 95% CI 0.93-1.03; I2 0%; P = 0.68). Four studies provided data about the secondary outcome, all showing significant reductions in air-bone gap, ranging from 5.7 to 11.0 in the endoscope group and from 5.8 to 11.6 in the microscope group, with a mean difference between groups of 0.85 (95% CI - 0.79 to 2.48). CONCLUSION: Although the overall evidence of the included studies was low, endoscopic and microscopic butterfly cartilage graft inlay tympanoplasties have similar results on anatomical and hearing outcomes, making the selection between such approaches an individual choice for the surgeon.
Authors: Matthew J Page; Joanne E McKenzie; Patrick M Bossuyt; Isabelle Boutron; Tammy C Hoffmann; Cynthia D Mulrow; Larissa Shamseer; Jennifer M Tetzlaff; Elie A Akl; Sue E Brennan; Roger Chou; Julie Glanville; Jeremy M Grimshaw; Asbjørn Hróbjartsson; Manoj M Lalu; Tianjing Li; Elizabeth W Loder; Evan Mayo-Wilson; Steve McDonald; Luke A McGuinness; Lesley A Stewart; James Thomas; Andrea C Tricco; Vivian A Welch; Penny Whiting; David Moher Journal: BMJ Date: 2021-03-29