RESUMO
OBJECTIVE: We aimed to perform a systematic review and meta-analysis of myringoplasty outcomes following platelet concentrates application in patients with chronic otitis media (COM). DATA SOURCES: We searched MEDLINE, Embase, and Cochrane Central register of Controlled Clinical Trials (CENTRAL). We also performed a manual search in Google Scholar and reference lists. REVIEW METHODS: Eligible for inclusion were randomized controlled trials on COM patients undergoing myringoplasty with platelet concentrates (platelet-rich plasma or platelet-rich fibrin) compared to myringoplasty alone. The primary outcomes were graft uptake and air-bone gap (ABG) gain, while the secondary outcome was complication rate. We used odds ratio (OR) and standardized mean difference (SMD) to represent dichotomous and continuous outcomes, respectively. RESULTS: Thirteen trials (n = 1179) were deemed eligible. Platelet concentrates significantly improved graft uptake after 6 months (OR: 2.45, 95% confidence interval [CI]: 1.34-4.47, P = .004, I2 = 0%, high certainty), ABG gain (SMD: 0.36, 95% CI: 0.17-0.55, P = .0002, I2 = 0%, moderate certainty), and complication rate (OR: 0.38, 95% CI: 0.18-0.82, P = .01, I2 = 0%, low certainty). CONCLUSION: Our results showed that platelet concentrates may improve graft uptake and ABG gain and reduce complications in COM patients undergoing myringoplasty. Caution is warranted given to the relatively small sample size, as well as inconsistent reporting across included trials.
RESUMO
PURPOSE: To compare the efficacy and safety of temporalis fascia (TF) with cartilage grafts for primary type 1 tympanoplasty in chronic otitis media (COM) patients. METHODS: Computerized search was performed in MEDLINE, Embase, and CENTRAL. Eligible for inclusion were randomized controlled trials (RCTs) comparing TF and cartilage grafts in individuals with non-cholesteatoma COM and intact ossicles requiring type 1 tympanoplasty. Primary outcomes were graft success and hearing improvement, measured by the air-bone gap (ABG) closure. The secondary outcome was the occurrence of complications. Standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals were calculated. RESULTS: Eighteen RCTs that enrolled 1273 participants were found eligible. Data were reported at follow-up periods ranging from 6 weeks to 24 months. The pooled effect estimate revealed a higher and statistically significant graft success favoring cartilage grafts at 12 months (OR = 2.24, 95% CI 1.33-3.78) and 24 months (OR = 2.96, 95% CI 1.18-7.43). There was no significant difference between both grafts in post-operative ABG closure across all follow-up periods (6 weeks to 12 months). CONCLUSIONS: Compared to TF, primary type 1 cartilage tympanoplasty offers better graft uptake rates and comparable postoperative hearing outcomes for COM patients.