Meta-Analysis of Tympanostomy Tube Sequelae

2001 ◽  
Vol 124 (4) ◽  
pp. 374-380 ◽  
Author(s):  
David J. Kay ◽  
Magalie Nelson ◽  
Richard M. Rosenfeld
Keyword(s):  
Relative Risk ◽  
Meta Analysis ◽  
Case Series ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Retraction Pocket ◽  
Medline Search ◽  
Tube Extrusion ◽  
Primary Indication

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). Meta-analysis 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.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

Helping Children with Special Needs: Who Receives Tympanostomy Tubes?

2021 ◽  
pp. 000348942098742
Author(s):  
David W. Wassef ◽  
Nehal Dhaduk ◽  
Savannah C. Roy ◽  
Gregory L. Barinsky ◽  
Evelyne Kalyoussef
Keyword(s):  
Developmental Disorders ◽  
Developmental Disorder ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Tube Placement ◽  
Hospital Charges ◽  
Tympanostomy Tube ◽  
Tube Insertion ◽  
Tympanostomy Tubes

Objectives: Tympanostomy tubes can prevent sequelae of otitis media that adversely affect long term hearing and language development in children. These negative outcomes compound the existing difficulties faced by children who are already diagnosed with developmental disorders. This study aims to characterize this subset of children with developmental disorders undergoing myringotomy and tympanostomy tube insertion. Methods: A retrospective review using the Kids’ Inpatient Database (KID) was conducted, with codes from International Classification of Diseases, Ninth Revision used to query data from the years 2003 to 2012 to determine a study group of children with a diagnosis of a developmental disorder undergoing myringotomy and tympanostomy insertion. This group was compared statistically to patients undergoing these procedures who did not have a diagnosed developmental disorder. Results: In total, 21 945 cases of patients with myringotomy with or without tympanostomy tube insertion were identified, of which 1200 (5.5%) had a diagnosis of a developmental disorder. Children with developmental disorders had a higher mean age (3.3 years vs 2.9 years, P = .002) and higher mean hospital charges ($43 704.77 vs $32 764.22, P = .003). This cohort also had higher proportions of black (17.6% vs 12.3%, P < .001) and Hispanic (23.9% vs 20.6%, P = .014) patients, and had lower rates of private insurance coverage (39.6% vs 49%, P < .001). Conclusion: The population of children with developmental disorders undergoing myringotomy or tympanostomy tube placement has a different demographic composition than the general population and faces distinct financial and insurance coverage burdens. Further study should be done to assess if these differences impact long term outcomes.

scholarly journals Proton pump inhibitors do not increase the risk of dementia: a systematic review and meta-analysis of prospective studies

2020 ◽  
Vol 33 (10) ◽  
Author(s):  
Madhav Desai ◽  
Venkat Nutalapati ◽  
Sachin Srinivasan ◽  
Jihan Fathallah ◽  
Chandra Dasari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Proton Pump ◽  
Prospective Studies ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Extensive Literature ◽  
Meta Regression

SUMMARY Published studies have reported variable results on the association between duration of proton pump inhibitor (PPI) use and the risk of dementia. An extensive literature search was performed in PubMed, Embase, Google Scholar, and Cochrane for studies examining the risk of cognitive decline and dementia among PPI users versus non-PPI users in prospective studies. Retrospective database linkage studies, case reports, case series, editorials, uncontrolled cohort studies, cross-sectional studies, and review articles were excluded. Primary outcome was pooled hazard rate (HR) of any dementia among PPI users compared with non-PPI users. Secondary outcomes were pooled HR of Alzheimer’s dementia (AD) and risk with long-term PPI follow-up (more than 5 years) studies. Meta-analysis outcomes, heterogeneity (I2), and meta-regression (for the effect of covariates) were derived by statistical software R and Open meta-analyst. A total of six studies (one RCT and five prospective) with 308249 subjects, average age of 75.8 ± 5.2 years, and follow-up of 5 (range 1.5–11) years were included in the analysis. Pooled HR of any dementia was 1.16 (n = 6, 95% confidence interval (CI) = 0.86–1.47). Results remained unchanged when only studies with long-term PPI use (more than 5 years) were analyzed (n = 4, pooled HR 1.10, 95% CI 0.66–1.53). Finally, the pooled HR for AD was 1.06 (n = 3, 95% CI 0.70–1.41). There was substantial heterogeneity among inclusion studies (I2 = 93%). Meta-regression did not demonstrate a significant role of age at study start (P = 0.1) or duration of PPI use (P = 0.62) to incident dementia. The results of this systematic review and meta-analysis do not show a significant relationship between PPI use and dementia in prospective studies with at least a 5-year follow-up.

scholarly journals Paclitaxel-Coated or Uncoated Devices: Significant Differences in Patient Populations and Mortality Led to Study Incomparability

2021 ◽  
Author(s):  
Chenyang Zhang ◽  
Guosheng Yin
Keyword(s):  
Relative Risk ◽  
Interim Analysis ◽  
Meta Analysis ◽  
Credible Interval ◽  
Mortality Rates ◽  
Control Groups ◽  
Random Effects Models ◽  
And Control

AbstractThe SWEDEPAD trial reported an unplanned interim analysis to show no difference in the mortality rate between the paclitaxel-coated and uncoated groups (Nordanstig et al., 2020), which contradicts the long-term risk of paclitaxel-coated devices claimed by a meta-analysis (Katsanos et al., 2018). However, there existed significant differences in mortality rates between the SWEDEPAD trial and the trials included in the meta-analysis, which were caused by significant differences in the patient populations. As a result, the SWEDEPAD trial and meta-analysis results are not directly comparable. An updated meta-analysis including the SWEDPEPAD trial and all studies in the meta-analysis (Katsanos et al., 2018) shows marginal differences in mortality rates between the paclitaxel-coated and control groups at two years with Bayesian relative risk (RR) 1.39 (95% credible interval (CrI) [1.01, 2.39]) and frequentist RR 1.16 (95% confidence interval (CI) [0.99, 1.36]) and differences in mortality rates during the entire follow-up period with Bayesian RR 1.29 (95% CrI [1.01, 1.72]) and frequentist RR 1.13 (95% CI [0.99, 1.28]) under random-effects models. Given the relatively short follow-up thus far in the SWEDEPAD trial (with a mean follow-up of 2.49 years) and the paclitaxel-coated risk being long-term (e.g., 4 or 5 years), the interim results on the risk of paclitaxel-coated devices reported by the SWEDEPAD trial warrant further investigation.

Long-Term Clinical and Angiographic Outcomes in Patients with Cervico-Cranial Dissections Treated with Stent Placement: A Meta-Analysis of Case Series

2012 ◽  
Vol 29 (7) ◽  
pp. 1342-1353 ◽  
Author(s):  
Ameer E. Hassan ◽  
Haralabos Zacharatos ◽  
Fotis Souslian ◽  
M. Fareed K. Suri ◽  
Adnan I. Qureshi
Keyword(s):  
Stent Placement ◽  
Meta Analysis ◽  
Case Series

scholarly journals Bilateral Adrenalectomy in Congenital Adrenal Hyperplasia: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 103 (5) ◽  
pp. 1767-1778 ◽  
Author(s):  
Diana MacKay ◽  
Anna Nordenström ◽  
Henrik Falhammar
Keyword(s):  
Congenital Adrenal Hyperplasia ◽  
Cushing Syndrome ◽  
Case Reports ◽  
Therapeutic Option ◽  
Meta Analysis ◽  
Case Series ◽  
Adverse Outcomes ◽  
Bilateral Adrenalectomy ◽  
Adrenal Hyperplasia

Abstract Context Management of congenital adrenal hyperplasia (CAH) involves suppression of the hypothalamic–pituitary–adrenal axis using supraphysiological doses of exogenous glucocorticoids. This can pose a challenge, with Cushing syndrome a frequent complication of adequate suppression. Bilateral adrenalectomy, with subsequent replacement of glucocorticoids and mineralocorticoids at physiological doses, has been proposed as an alternative therapeutic strategy. Objective To review the outcomes after bilateral adrenalectomy for CAH. Data Sources A systematic search of PubMed/MEDLINE and Web of Science, identifying relevant reports published up to 10 January 2018. Study Selection Case reports or case series were included if they reported individual patient data from patients with CAH who had undergone bilateral adrenalectomy. Data Extraction Information regarding the following was extracted: first author, country, sex, age at adrenalectomy, year of adrenalectomy, diagnosis, molecular abnormality, pre- and postoperative biochemistry, pre- and postoperative medications, pre- and postoperative body mass index, indication for adrenalectomy, surgical technique, gross and microscopic adrenal characteristics, follow-up duration, and short- and long-term postoperative outcomes. Data Synthesis We identified 48 cases of bilateral adrenalectomy for CAH, with patients aged from 4 months to 56 years at surgery. The most common indication for surgery was the inability to control hyperandrogenism/virilization and/or Cushing syndrome (n = 30; 62%). Most patients (n = 34; 71%) reported symptomatic improvement postoperatively, with some cases of short-term (n = 5; 10%) and long-term (n = 13; 27%) adverse outcomes. Conclusions Bilateral adrenalectomy for CAH appears to be a reasonable therapeutic option for carefully selected patients who have had unsatisfactory outcomes with conventional medical management.

Smoke and Ear Effusions

PEDIATRICS ◽  
1987 ◽  
Vol 79 (2) ◽  
pp. 309-311
Author(s):  
RUTH A. ETZEL
Keyword(s):  
American Academy ◽  
Middle Ear ◽  
Tobacco Smoke ◽  
Health Effect ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Adverse Health Effect ◽  
American Academy Of Pediatrics ◽  
Involuntary Smoking

To the Editor.— The Committee on Environmental Hazards of the American Academy of Pediatrics has reviewed the acute and long-term health effects of involuntary smoking and offered recommendations to reduce the exposure of children to tobacco smoke.1 Chronic middle ear effusions requiring tympanostomy tube placement occur more often in the children of parents who smoke than in the children of parents who do not smoke.2,3 Although not mentioned in the Committee's statement, this is another important adverse health effect associated with involuntary smoking about which both parents and pediatricians should be informed.

Union rates after proximal scaphoid fractures; meta-analyses and review of available evidence

2012 ◽  
Vol 38 (8) ◽  
pp. 888-897 ◽  
Author(s):  
N. Eastley ◽  
H. Singh ◽  
J. J. Dias ◽  
N. Taub
Keyword(s):  
Relative Risk ◽  
Computer Tomography ◽  
Meta Analysis ◽  
Comprehensive Analysis ◽  
Power Calculations ◽  
Scaphoid Fractures ◽  
Meta Analyses

We carried out a comprehensive analysis of publications to investigate long term union rates of acute proximal scaphoid fractures. Of 1147 acute scaphoid fractures managed nonoperatively that were available for analysis, 67 (5.8%) were proximal. Amalgamating publications revealed that 34% of acute proximal scaphoid fractures progress to nonunion when managed nonoperatively. A meta-analysis showed that the relative risk of nonunion for these fractures is 7.5 compared with more distal fractures, also managed nonoperatively. More trials are needed to allow direct comparison of acute proximal scaphoid fractures managed operatively and nonoperatively. Power calculations indicate that 76 cases will need to be recruited for such a study. Currently, the proximal scaphoid is defined inconsistently. To avoid misclassification we suggest the region is defined as the proximal fifth of the bone, and computer tomography is used during follow-up.

scholarly journals P.023 Neurostimulation in Drug-Resistant Epilepsy: Systematic Review and Meta-Analysis from the ILAE Evidence-Based Epilepsy Surgery Task Force

2021 ◽  
Vol 48 (s3) ◽  
pp. S26-S26
Author(s):  
L Touma ◽  
B Dansereau ◽  
D Englot ◽  
MR Keezer
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Meta Analysis ◽  
Case Series ◽  
Current Evidence ◽  
Drug Resistant ◽  
Seizure Reduction ◽  
Drug Resistant Epilepsy

Background: Drug-resistant epilepsy (DRE) can affect up to one third of individuals with epilepsy. We conducted a systematic review and meta-analysis of vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) in patients with DRE to summarize the current evidence on efficacy and tolerability for these neuromodulation modalities. Methods: We searched three online databases with a pre-specified search strategy. We included published randomized controlled trials (RCT) and their open-label extension studies, as well as prospective case series, with samples greater than 20 participants, reporting efficacy and tolerability. Results: We identified 31 studies, six of which are RCTs and 25 prospective observational studies. At long term follow-up, five observational studies for VNS reported a pooled mean decrease in seizure frequency at last follow-up of 35%. In the extension studies for RNS, the median seizure reduction was 53%, 66% and 75.0% at two, five and nine years respectively. For DBS, the median reduction was then 56%, 69% and 75% at two, five and seven years respectively. Conclusions: Neurostimulation modalities are effective for the treatment of DRE, with improving outcomes over time and few major complications. Higher quality long-term data on DBS and RNS suggest larger seizure reduction rates than VNS.

scholarly journals Management of solitary fibrous tumours of the pleura: a systematic review and meta-analysis

2020 ◽  
Vol 6 (3) ◽  
pp. 00055-2020
Author(s):  
Rachel M. Mercer ◽  
Charlotte Wigston ◽  
Radhika Banka ◽  
Giuseppe Cardillo ◽  
Rachel Benamore ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Meta Analysis ◽  
Case Series ◽  
R0 Resection ◽  
Recurrence Rates ◽  
Solitary Fibrous Tumours ◽  
Rare Tumours ◽  
First Recurrence ◽  
Evidence Based Guidelines

BackgroundSolitary fibrous tumours of the pleura (SFTP), or pleural fibromas, are rare tumours that generally, but not universally, follow a benign course. Surgical resection is the standard treatment, but there are no evidence-based guidelines regarding the management of these tumours.MethodsFive databases were searched from inception to April 1, 2019 for studies reporting on SFTP management.ResultsTwenty-seven studies met the inclusion criteria (1542 patients, all non-comparative case series); 98% of these patients underwent resection and all SFTP included were pathologically diagnosed. 394 out of 1299 cases (30.5%, 95% CI 27.8–32.8%) were malignant with recurrence rates of between 0% and 42.9%. A pleural effusion was always associated with a negative outcome, but no other features were consistently reported to have negative associations. Preoperative biopsies incorrectly reported malignant histology in two studies. Over 25% of cases of recurrence occurred when a complete (R0) resection had been achieved. The first recurrence occurred >5 years after the initial resection in at least 23% of cases.ConclusionsThere is strong evidence to support long-term surveillance after surgical resection of SFTP, even where a complete (R0) resection has been achieved; however, there is no clear evidence to inform clinicians regarding the selection of patients who should undergo resection. The rates of malignant SFTP and SFTP recurrence are higher than previously reported. Only those that were pathologically diagnosed or resected were included, which may bias the data towards more aggressive tumours. Data collection on radiologically diagnosed SFTP is required to draw conclusions regarding the timing and need for intervention.

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