Comparative efficacy of tympanostomy tube insertion for secretory otitis media following radiotherapy for head and neck malignancies: a network meta-analysis.
Background: There is no consensus regarding the optimal management of postradiation secretory otitis media (SOM) in patients with head and neck malignancies. Objectives: In this network meta-analysis, we compared the efficacy and complication profiles of tympanostomy tube insertion (TI), laser tympa...
| Publicado en: | Acta Oto-Laryngologica Vol. 146; no. 5; pp. 633 - 645 |
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| Autores principales: | , , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Taylor & Francis Ltd
May2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| Sumario: | Background: There is no consensus regarding the optimal management of postradiation secretory otitis media (SOM) in patients with head and neck malignancies. Objectives: In this network meta-analysis, we compared the efficacy and complication profiles of tympanostomy tube insertion (TI), laser tympanostomy (LT), tympanocentesis (TC), intratympanic injection (ITI), and TI combined with injection (TI+I). Methods: Sixteen studies (nine randomized controlled trials [RCTs] and seven semi-RCTs; 1464 participants) were analyzed using Stata 15.0. Primary outcomes included treatment efficacy based on the Surface Under the Cumulative Ranking Curve (SUCRA) and complication rates, specifically suppurative otitis media and tympanic membrane perforation. Results: Efficacy rankings were as follows: ITI < TC < TI < TI+I < LT, with SUCRA values highest for LT (97.3%) and TI+I (71.3%). LT and TI+I showed greater symptom relief and hearing improvement than the other interventions. Complication rates were the lowest for LT (suppurative otitis: 13.2%; tympanic perforation: 14.2%) and the highest for ITI (77.3% and 70.4%, respectively). TI performed with preinsertion ambroxol or triamcinolone was associated with a reduced recurrence rate. Conclusions: Laser tympanostomy offers optimal efficacy and safety for postradiation SOM, with TI+I representing a feasible alternative. ITI and TC were associated with higher complication risks. Key limitations include short follow-up duration for LT and the predominance of unblinded study designs. 目前对于头颈部恶性肿瘤患者放疗后分泌性中耳炎(SOM)的最佳治疗方案尚无共识。 本网络荟萃分析比较了鼓膜置管术(TI)、激光鼓膜切开术(LT)、鼓膜穿刺术(TC)、鼓室内注射(ITI)以及鼓膜置管联合注射(TI+I)的疗效和并发症情况。 本研究纳入16项研究(9项随机对照试验[RCT]和7项半随机对照试验；共1464名受试者), 并使用Stata 15.0软件进行分析。主要结局指标包括基于累积排名曲线下面积(SUCRA)的治疗疗效和并发症(特别是化脓性中耳炎和鼓膜穿孔)的发生率, 。 疗效排名如下: ITI < TC < TI < TI+I < LT, 其中 LT 的 SUCRA 值最高(97.3%), 其次是 TI+I(71.3%)。LT 和 TI+I 的症状缓解和听力改善效果优于其他干预措施。LT 的并发症发生率最低(化脓性中耳炎: 13.2%；鼓膜穿孔: 14.2%), 而 ITI 的并发症发生率最高(分别为 77.3% 和 70.4%)。术前使用氨溴索或曲安奈德进行 TI 可降低复发率。 激光鼓膜切开术治疗放射后中耳炎具有最佳的疗效和安全性, 鼓膜置管联合注射是一种可行的替代方案。鼓室内注射 和 鼓膜穿刺术的并发症风险较高。 主要局限性包括激光鼓膜切开术随访时间短以及非盲研究设计占主导地位。 |
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