Cochrane reviews of surgical treatments

The systematic review in otolaryngology: a guide to preparation

“…5 Further, among non-Cochrane published ENT reviews and meta-analyses, they identified 190 on non-surgical, but only 33 on surgical topics, these mostly relating to epidemiology rather than efficacy of the intervention. Further criticism 6 suggested that any statement suggesting no evidence of benefit be accompanied by a warning that this does not mean the treatment is ineffective, by an explanation as to why randomised controlled trials (RCTs) are more difficult for surgical topics and by advice to health care commissioners to consult with local experts, before any precipitate response. Indeed lack of evidence of effect is not evidence of lack of effect!…”

Response to Freeman

“…We agree with Freeman that most clinical practice in otolaryngology is not supported by high level evidence. There are often good reasons why randomised controlled trial (RCT) evidence is unavailable 8 . RCT’s are not usually done on procedures with an established, long history of clinical effectiveness behind them.…”