Meta-analysis of tympanostomy tube sequelae
Meta-analysis of tympanostomy tube sequelae
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DOI：
10.1067/mhn.2001.113941
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发表时间：
2001-04-01
影响因子：
3.4
通讯作者：
Rosenfeld, RM
中科院分区：
文献类型：
--
作者：
Kay, DJ;Nelson, M;Rosenfeld, RM
目的：通过对已发表的病例系列和随机研究的系统回顾，估计鼓膜造口管后遗症的发生率。数据来源：1966年至1999年4月的英文MEDLINE检索，手动参考检索会议记录、文章、报告和指南。研究选择：以中耳炎作为鼓膜造口管放置主要适应症的队列研究。数据提取：资料综合：术后暂时性耳畸形发生率为16%，以后发生率为26%，复发性耳畸形发生率为7.4%，慢性耳畸形发生率为3.8%。留置管的后遗症包括阻塞（7%的耳）、肉芽组织（5%）、过早挤出（3.9%）和内侧移位（0.5%）。拔管后的后遗症包括鼓膜凹陷（32%）、局灶性萎缩（25%）、回缩袋（25%）、（3.1%），中耳瘤（0.7%），穿孔（短期插管2.2%，长期插管16.6%），荟萃分析显示长期插管使穿孔的相对风险增加3.5（95% CI，1.5 - 7.1），并且中耳炎增加2.6（95%CI，1.5 - 4.4），同样，插管使鼓膜炎的相对风险增加3.5（95% CI，2.6 - 4.9），局灶性萎缩1.7（95% CI，1.1 - 2.7）与未插管对照耳相比（基线鼓膜肿胀率和萎缩率分别为10%和14%）。鼓膜造孔管的后遗症很常见，但通常是短暂的（耳漏）或美容性的（鼓膜硬化、局灶性萎缩）。尽管如此，高发病率表明需要对所有留置管的患者进行持续的耳科监测，并在拔管后保持合理的时间。应选择性和个性化地使用长期管。
OBJECTIVE: To estimate the incidence of tympanostomy tube sequelae based on systematic review of published case series and randomized studies.DATA SOURCES: English-language MEDLINE search from 1966 through April 1999 with manual reference search of proceedings, articles, reports, and guidelines.STUDY SELECTION: Cohort studies with otitis media as the primary indication for tube placement.DATA EXTRACTION: Two reviewers independently extracted data from 134 articles.DATA SYNTHESIS: Transient otorrhea occurred in 16% of patients in the postoperative period and later in 26%; recurrent otorrhea occurred in 7.4% of patients and chronic otorrhea in 3.8%. Sequelae of indwelling tubes included obstruction (7% of ears), granulation tissue (5%), premature extrusion (3.9%), and medial displacement (0.5%). Sequelae after tube extrusion included tympanosclerosis (32%), focal atrophy (25%), retraction pocket (3.1%), cholesteatoma (0.7%), and perforation (2.2% with short-term tubes, 16.6% with long-term tubes), Metaanalysis showed that long-term tubes increased the relative risk of perforation by 3.5 (95% CI, 1.5 to 7.1) and cholesteatoma by 2.6 (95% CI, 1.5 to 4.4), Similarly, intubation increased the relative risk of tympanosclerosis by 3.5 (95% CI, 2.6 to 4.9) and focal atrophy by 1.7 (95% CI, 1.1 to 2.7) over nonintubated control ears (baseline tympanosclerosis and atrophy rates of 10% and 14%, respectively).CONCLUSIONS: Sequelae of tympanostomy tubes are common but are generally transient (otorrhea) or cosmetic (tympanosclerosis, focal atrophy). Nonetheless, the high incidence suggests a need for ongoing otologic surveillance of all patients with indwelling tubes and for a reasonable time period after tube extrusion. Long-term tubes should be used on a selective and individualized basis.