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Acta Otorhinolaryngologica Italica :... Aug 2018The aim of this study is to perform a systematic review and meta-analysis of observational studies in which hearing outcomes after primary stapes surgery have been... (Comparative Study)
Comparative Study Meta-Analysis
The aim of this study is to perform a systematic review and meta-analysis of observational studies in which hearing outcomes after primary stapes surgery have been reported. After the surgical procedure, the effectiveness of stapes surgery using nickel titanium (Nitinol) or other prostheses were systematically compared and evaluated using a meta-analytic method. A systematic search for articles before January 2017 in Embase, Medline and Cochrane Library databases was conducted. Only articles in English were included. Inclusion criteria for qualitative synthesis consisted of a population of otosclerosis patients, intervention with primary stapes surgery using the Nitinol heat-crimping prosthesis compared with other type of stapes stapedotomy prostheses, and hearing outcome. Inclusion criteria for quantitative analysis consisted of application of audiometry guidelines of the American Academy of Otolaryngology Head and Neck Surgery Committee on Hearing and Equilibrium for evaluation of conductive hearing loss. A postoperative air-bone gap (ABG) ≤ 10 dB was considered effective. A bias assessment tool was developed according to Cochrane guidelines. To evaluate the mean age of the samples we used the chi-square test. Of the 4926 papers identified through the electronic database search (3695 in Pubmed/Cochrane and 1231 in Embase), 540 studies matched the selection criteria (436 in Pubmed/Cochrane and 104 in Embase) after application of filters and elimination of duplicate articles. After analysis of the title and abstract, 459 were excluded (396 in Pubmed/Cochrane and 63 in Embase). Of the remaining 81 papers, 74 were excluded according to the study selection criteria. A total of seven eligible studies with 1385 subjects, consisting of 637 in the Nitinol group and 748 in the non-Nitinol group, were included in our study. There were statistically significant differences in the effectiveness of stapes surgery between the Nitinol and non-Nitinol prostheses; the data showed a combined odds ratio (OR) of 2.56 (95% CI 1.38-4.76, p = 0.003). There were no statistically significant differences in the mean pre-operative age between Nitinol and non-Nitinol prostheses (p = 0.931). Our results suggest that the effectiveness of Nitinol was higher than non-Nitinol prostheses, with superiority of the number of patients with ABG ≤ 10 dB.
Topics: Alloys; Humans; Observational Studies as Topic; Ossicular Prosthesis; Otosclerosis; Prosthesis Design; Stapes Surgery
PubMed: 30197420
DOI: 10.14639/0392-100X-1950 -
Stapedotomy vs Cochlear Implantation for Advanced Otosclerosis: Systematic Review and Meta-analysis.Otolaryngology--head and Neck Surgery :... Nov 2016To compare the hearing outcomes of stapedotomy vs cochlear implantation in patients with advanced otosclerosis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To compare the hearing outcomes of stapedotomy vs cochlear implantation in patients with advanced otosclerosis.
DATA SOURCES
PubMed, EMBASE, and The Cochrane Library were searched for the terms otosclerosis, stapedotomy, and cochlear implantation and their synonyms with no language restrictions up to March 10, 2015.
METHODS
Studies comparing the hearing outcomes of stapedotomy with cochlear implantation and studies comparing the hearing outcomes of primary cochlear implantation with salvage cochlear implantation after an unsuccessful stapedotomy in patients with advanced otosclerosis were included. Postoperative speech recognition scores were compared using the weighted mean difference and a 95% confidence interval.
RESULTS
Only 4 studies met our inclusion criteria. Cochlear implantation leads to significantly better speech recognition scores than stapedotomy (P < .0001). However, this appears to be due to the variability in outcomes after stapedotomy. Cochlear implantation does not lead to superior speech recognition scores compared with the subgroup of successful cases of stapedotomy plus hearing aid (P = .47). There is also no significant difference with respect to speech recognition between primary cochlear implantation and those secondary to a failed stapedotomy (P = .22).
CONCLUSIONS
Cochlear implantation leads to a statistically greater and consistent improvement in speech recognition scores. Stapedotomy is not universally effective; however, it yields good results comparable to cochlear implantations in at least half of patients. For cases of unsuccessful stapedotomy, the option of cochlear implantation is still open, and the results obtained through salvage cochlear implantation are as good as those of primary cochlear implantation.
Topics: Cochlear Implantation; Humans; Otosclerosis; Outcome and Process Assessment, Health Care; Salvage Therapy; Stapes Surgery
PubMed: 27329418
DOI: 10.1177/0194599816655310 -
Otology & Neurotology : Official... Jan 2016To evaluate the diagnostic value of computed tomography (CT) in detecting otosclerosis in patients with conductive hearing loss and a clinical suspicion of otosclerosis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the diagnostic value of computed tomography (CT) in detecting otosclerosis in patients with conductive hearing loss and a clinical suspicion of otosclerosis.
DATA SOURCES
PubMed, Embase, and the Cochrane Library.
STUDY SELECTION
A systematic search was conducted. Studies reporting original study data were included.
DATA EXTRACTION
Relevance and risk of bias of the selected articles were assessed. Studies with low relevance, high risk of bias, or both were excluded. Prevalences, sensitivities, specificities, and post-test probabilities were extracted from the included articles.
DATA SYNTHESIS
Seven studies characterized by a moderate to high relevance and moderate to low risk of bias were included for data extraction. The prevalence of otosclerosis was high (up to 100%) in the majority of the included studies. In those studies with a high prevalence of disease, both positive and negative post-test probabilities were (relatively) high: 99% and between 51% and 67% respectively. In one study with a low prevalence of disease (9%), both positive and negative post-test probabilities were low (23% and 3% respectively). Overall, reported sensitivities ranged between 60% and 95%.
CONCLUSION
Preoperative CT has little to add in establishing otosclerosis and may not be necessary to confirm the diagnosis. We would recommend reserving CT for those patients with suspected additional abnormalities, for specific preoperative planning, or out of legal necessity.
Topics: Hearing Loss, Conductive; Humans; Otosclerosis; Reproducibility of Results; Tomography, X-Ray Computed
PubMed: 26649602
DOI: 10.1097/MAO.0000000000000924 -
The Laryngoscope May 2016To evaluate the effect of crimping techniques in stapes surgery for otosclerosis patients measured by hearing outcomes on pure-tone audiometry. (Review)
Review
OBJECTIVES/HYPOTHESIS
To evaluate the effect of crimping techniques in stapes surgery for otosclerosis patients measured by hearing outcomes on pure-tone audiometry.
DATA SOURCES
PubMed, EMBASE, and the Cochrane Library.
METHODS
A systematic search was conducted. Studies comparing the effect of different crimping methods on pure-tone audiometric results in patients undergoing stapes surgery for otosclerosis were included. Relevance and risk of bias were assessed. Absolute risks and risk differences, means and mean differences, and 95% confidence intervals were extracted or calculated for the primary and secondary outcomes, which were air-bone gap closure to 10 dB or less, mean postoperative air-bone gap, and postoperative sensorineural hearing loss.
RESULTS
Twenty-two studies with moderate or high risk of bias were included for data extraction. Air-bone gap closure to 10 dB or less was assessed in 17 studies and mean postoperative air-bone gap in 20 studies. The hearing outcomes did not consistently favor one crimping method. However, the differences that were statistically significant were consistently in favor of heat crimping over manual and no crimping (difference in air-bone gap closure to 10 dB or less ranged between 22% and 42% in these studies and difference in mean postoperative air-bone gap between 2.8 dB and 7.4 dB) and in favor of manual crimping over no crimping (30% difference in air-bone gap closure to 10 dB or less and difference in mean postoperative air-bone gap between 2.6 dB and 6.0 dB).
CONCLUSION
Moderate to high risk of bias and inconsistent results characterize the current evidence. Laryngoscope, 126:1207-1217, 2016.
Topics: Audiometry, Pure-Tone; Hearing Loss, Sensorineural; Humans; Otosclerosis; Postoperative Complications; Stapes Surgery
PubMed: 26333166
DOI: 10.1002/lary.25586 -
The Laryngoscope Jan 2016To evaluate the effect of piston diameter in primary stapedotomy for otosclerosis patients measured by hearing outcome. (Review)
Review
OBJECTIVE
To evaluate the effect of piston diameter in primary stapedotomy for otosclerosis patients measured by hearing outcome.
DATA SOURCES
PubMed, Embase, and the Cochrane Library.
REVIEW METHODS
A systematic search was conducted. Studies reporting original data on the effect of piston diameter on pure-tone audiometric results in patients undergoing primary stapedotomy for otosclerosis were included. Relevance and risk of bias of the selected articles were assessed. Studies with low relevance, high risk of bias, or both were excluded. Absolute risks and risk differences, means and mean differences, and 95% confidence intervals were extracted.
RESULTS
Twelve studies with moderate to high relevance and moderate risk of bias were included for data extraction. Air-bone gap closure to 10 dB or less was assessed in six studies, the majority of which did not show a statistically significant or clinically relevant difference between two pistons with a different diameter. More importantly, the differences that were found were not consistently in favor of smaller-diameter pistons or larger-diameter pistons. Mean postoperative air-bone gap ranged from 3 dB in favor of a smaller-diameter piston to 3 dB in favor of a larger-diameter piston across four studies. Permanent sensorineural hearing loss was assessed in eight studies and occurred in only one study. In this study, no difference was found between a 0.4-mm-diameter piston and a 0.6-mm-diameter piston.
CONCLUSION
There is not sufficient evidence to support the superiority of the use of a larger-diameter piston compared to a smaller-diameter piston for primary stapedotomy in otosclerosis patients.
Topics: Audiometry, Pure-Tone; Hearing Loss; Humans; Otosclerosis; Stapes Surgery
PubMed: 26108164
DOI: 10.1002/lary.25408 -
The Laryngoscope Jan 2016To assess published reports in the literature on surgical success rates in patients with congenital stapes fixation (CSF) and juvenile otosclerosis (JO). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To assess published reports in the literature on surgical success rates in patients with congenital stapes fixation (CSF) and juvenile otosclerosis (JO).
DESIGN
Systematic review of the literature and meta-analysis of published data.
DATA SOURCES
PubMed, SAGE, MEDLINE, and Cochrane.
REVIEW METHODS
A literature search was performed and evaluated based on established criteria. Two independent reviewers (b.a., m.b.) inspected titles and abstracts of the studies. The full texts of the studies were examined to assess their relevance to the meta-analysis. An air-bone gap (ABG) of 0 to 10 dB hearing level was described as success of surgery.
RESULTS
A random effects model was used to analyze the data. A total of 27 studies were included in the meta-analysis, whereas 934 were excluded. The total number of operated ears was 445 (256 ears with JO and 189 ears with CSF). At the time of surgery, the age of the patients ranged from 3 to 18 years. The success rate was 80.2% for JO and 54% for CSF. The overall success rate was 69.9%. The rate of postoperative sensorineural hearing loss was 3.4% for JO and 2.1% for CSF.
CONCLUSIONS
Overall, stapes surgery in children with JO or CSF has a moderate success rate (69.9%) to provide ABG closure of 10 dB. The success rate for CSF in the setting of ossicular abnormalities is 54%. This meta-analysis suggests that if JO can be determined before surgery, a higher success rate is possible (80.2%).
Topics: Child; Humans; Otosclerosis; Outcome and Process Assessment, Health Care; Stapes Surgery
PubMed: 25963343
DOI: 10.1002/lary.25368 -
Otology & Neurotology : Official... Dec 2014To evaluate the effect of stapedotomy in cochlear implant candidates with far-advanced otosclerosis (FAO). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the effect of stapedotomy in cochlear implant candidates with far-advanced otosclerosis (FAO).
DESIGN
Systematic review of literature and meta-analysis.
DATA SOURCES
PubMed, EMBASE, and Cochrane databases were searched for "stapedotomy" and "far-advanced otosclerosis" and their synonyms. The search was carried out on November 28, 2013; no language restrictions were applied.
STUDY SELECTION
The initial search yielded 243 articles; a total of nine articles met our inclusion criteria (i.e., patients with FAO and aided speech recognition scores of ≤50%) and were included in this review. In addition, a group of five patients (seven stapedotomies) of our own center was also included in this meta-analysis.
DATA EXTRACTION
The methodologic quality of included studies was assessed by examining the study design, level of evidence, method of measurement, and adequacy of outcome reporting. The speech recognition scores before and after stapedotomy as well as the pure-tone average before and after stapedotomy were extracted.
DATA SYNTHESIS
A random-effects model was fitted for calculating weighted means. The mean preoperative speech recognition score was 11%; stapedotomy resulted in a mean postoperative speech recognition score of 59%. The mean preoperative and postoperative pure-tone averages were 112 dB HL and 80 dB HL, respectively. Seventy-two percent of the patients no longer met the criterion for cochlear implantation (CI) (i.e., <50% speech recognition), and 35% of the patients reached a postoperative aided speech recognition of more than 80%.
CONCLUSION
Stapedotomy combined with hearing aid fitting results in a good outcome in a substantial amount of CI candidates with FAO. We feel that a stapedotomy should be attempted before considering CI in all patients with FAO. In patients with bilateral otosclerosis, a contralateral stapedotomy may offer patients the benefits of binaural processing. If bilateral stapedotomy yields an unsatisfactory outcome, the option for CI is still open.
Topics: Cochlear Implantation; Cochlear Implants; Humans; Otosclerosis; Stapes Surgery; Treatment Outcome
PubMed: 25393972
DOI: 10.1097/MAO.0000000000000637 -
Auris, Nasus, Larynx Aug 2014To compare and evaluate the hearing outcome and complications of otosclerosis treated with the laser or non-laser stapedotomy using meta-analysis. (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
To compare and evaluate the hearing outcome and complications of otosclerosis treated with the laser or non-laser stapedotomy using meta-analysis.
METHODS
A thorough search for publications and "in-process" articles with English abstract dating from January 1978 to July 2013 was conducted using Pubmed, EBSCO and Web of Science databases, as well as all related papers. The included criteria were otosclerosis as diagnosis, clear description of surgical methods, calibrated stapedotomy and regular collection of functional results. Hearing results and other comparable data (age, preoperative hearing status, and mean length of follow-up) were collected from the articles.
RESULTS
Eleven studies with a total of 1614 subjects were identified to meet our criteria. There was a significant difference in the efficacy of stapedotomy with the laser or non-laser technique; current data showed a combined RR of 1.07 (95% CI: 1.02-1.13, p=0.005). But, the postoperative complication showed no advantage for the laser group, with a combined RR of 0.63 (95% CI: 0.30-1.34, p=0.23). Although there was publication bias in this study (p=0.005), the funnel plot would turn out to be symmetrical after six more studies were added by the trim and fill method.
CONCLUSION
Our overall results suggest that the laser stapedotomy had significantly better hearing results than non-laser stapedotomy. However, current papers on laser and non-laser stapedotomy did not provide enough subjects to make a subgroup analysis of the hearing outcome between different laser groups. More studies reporting different laser techniques are required to provide us with a better understanding of laser stapedotomy.
Topics: Adult; Evaluation Studies as Topic; Follow-Up Studies; Hearing; Humans; Laser Therapy; Odds Ratio; Otosclerosis; Postoperative Complications; Stapes Surgery; Treatment Outcome
PubMed: 24572322
DOI: 10.1016/j.anl.2013.12.014