Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta‐analysis

We would like to thank you for the opportunity to reply to Mr Faramarzi's valuable comment about our manuscript titled: Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta-analysis. 1 We agree with many of their points, especially on the surgical heterogeneity of our analyses, which was mentioned in our study as a limitation. Mastoid obliteration is not yet universally accepted as a surgical technique, and there is no clear consensus regarding its indication. Typically, the included studies did not detail the indication for mastoid obliteration, whether it was applied for extended diseases or smaller cholesteatomas as well. Thus, addressing different surgical techniques with mastoid obliteration to different extensions of cholesteatomas can be only an assumption. Moreover, using the endoscope in cholesteatoma surgery to control difficult areas helps preserving the posterior wall and avoid radical surgery even in advanced diseases.

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confidence: 87%

Reply to Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta‐Analysis

Illés

Horváth

2023

The Laryngoscope

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“…The main limitation of the technique is the inability to explore the mastoid cavity during follow-up with the risk of developing a “silent cholesteatoma”, making radiological follow-up essential. This technique has become popular in the last two decades with the development of non-EPI DW-MRI, which facilitates detection of cholesteatoma in obliterated or reconstructed cavities 30 . Surgical techniques and materials used for obliteration and reconstruction vary widely.…”

Section: Mastoid Obliterationmentioning

confidence: 99%

“…However, there is still no consensus around the technique, type of material to be used, or the ideal timing for surgery (simultaneous or during revision surgery) 32 . A systematic review and meta-analysis by Illes et al 30 collected data from 2077 operations from 11 articles to evaluate the effectiveness of mastoid obliteration compared to the CWU technique. The results demonstrated that mastoid obliteration significantly reduced cholesteatoma recidivism (Odds Ratio = 0.45, Confidence Interval = 0.26-0.8, p = 0.014).…”

Section: Mastoid Obliterationmentioning

confidence: 99%

Recurrence in cholesteatoma surgery: what have we learnt and where are we going? A narrative review

Bovi¹,

Luchena²,

Bivona³

et al. 2023

Acta Otorhinolaryngol Ital

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SUMMARY Treatment of cholesteatoma is surgical and has historically encompassed two main techniques: canal wall up (CWU) and canal wall down (CWD) tympanoplasty. Follow-up for cholesteatoma is still debated and can be either radiological or with second-look surgery. MRI with diffusion weighted sequences has proved to have high sensitivity and specificity in detecting recurrent or residual disease. Specifically, non-echo planar imaging DWI (non-EPI DWI) has been shown to be superior to other imaging techniques, allowing, in some cases, to avoid second-look surgery. Both residual and recurrence rates are higher in CWU compared to CWD procedures. Endoscopic ear surgery (EES) has become popular with the advantage of “looking around corners”. The endoscope is used in addition to a microscope or exclusively to reduce cholesteatoma recurrence. In addition, it has been demonstrated that mastoid obliteration and the use of potassium titanyl phosphate laser (KTP) can reduce cholesteatoma recurrence, with better functional outcomes. A synthetic sulphur compound (MESNA) may have an interesting role in the overall improvement in recurrence and residual cholesteatoma disease. This narrative review critically appraises the factors associated with the risk of recurrent cholesteatoma.

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We read with great interest the meta-analysis by Illés et al 1 on the beneficial effect of mastoid obliteration over the canal wall-up technique for cholesteatoma surgery. The authors included 11 studies in the systematic review and 8 in the quantitative analysis, with a total of 1847 patients.

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confidence: 99%

In Reference to Robustness of the Clinical Benefit of Mastoid Obliteration Technique for Cholesteatoma Surgery

et al. 2023

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We read with great interest the meta-analysis by Illés et al. 1 on the beneficial effect of mastoid obliteration over the canal wall-up technique for cholesteatoma surgery. The authors included 11 studies in the systematic review and 8 in the quantitative analysis, with a total of 1847 patients. The primary outcome was the odd of recurrent and residual disease. They also compared the quality of life, hearing results, infection rates, operation time, and rate of discharge as secondary outcomes.This meta-analysis showed a reduced odds ratio of recurrent and residual disease in patients treated with the mastoid obliteration technique, whilst no differences were found for the secondary outcomes between the two groups.To define the robustness of these findings and to establish the need for further research, we think the manuscript would benefit from a trial-sequential analysis (TSA) with the calculation of the required "information size" and estimation of the power of the meta-analysis.To provide such information, data were inserted in the TSA Software (Copenhagen Trial Unit's Software ® ), and the information size was computed assuming an alpha risk of 5% with a power of 80%. We used a random effect model with the outcome analyzed as odds ratio. The estimated outcome effects were computed using a weighted average from the included studies. Further details on TSA and its interpretation are available elsewhere. 2,3 We conducted the TSA on the investigated primary outcome. In this case, the Z-curve crossed the alpha spending boundary (O'Brien-Fleming method), showing the statistical robustness of the findings. Indeed, the mastoid obliteration technique significantly reduced the odds of recurrent and residual disease; moreover, the overall number of patients was slightly higher than the estimated "information size" (n = 1847/1844), thus confirming the adequacy of the sample recruited.

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Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta‐analysis

Cited by 8 publications

References 45 publications

Reply to Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta‐Analysis

Reply to Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta‐Analysis

Recurrence in cholesteatoma surgery: what have we learnt and where are we going? A narrative review

In Reference to Robustness of the Clinical Benefit of Mastoid Obliteration Technique for Cholesteatoma Surgery

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