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Efficacy of gelfoam middle ear packing in type-1 tympanoplasty: systematic review and meta-analysis

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Abstract

Purpose

To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluated the surgical outcomes of type-1 tympanoplasty with and without gelfoam middle ear packing.

Methods

PubMed, CENTRAL, Scopus, Web of Science, and Google Scholar databases were screened from inception until October 2022. The included RCTs were evaluated for risk of bias, and the quality of each outcome was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Results

Nine RCTs with 773 participants (gelfoam = 381 and non-gelfoam = 392) were analyzed. The overall study quality varied: low risk (n = 4 RCTs), some concerns (n = 3 RCTs), and high risk (n = 2 RCTs). There were no significant differences between both arms regarding the graft uptake rate (moderate certainty), hearing improvement rate (moderate certainty), type of impedance audiometry (moderate certainty), and ear discharge (low certainty). The mean change in air–bone gap was significantly higher in the non-gelfoam arm compared with the gelfoam arm (low certainty). However, the non-gelfoam group had superior hearing improvement in only the early postoperative period (i.e., one month); however, after two, three, and six months, there were no significant differences between both arms. The rate of ear fullness was significantly higher in the gelfoam arm compared with the non-gelfoam arm (moderate certainty).

Conclusion

Among patients undergoing type-1 tympanoplasty, the surgical outcomes did not significantly differ between both arms. The practice of middle ear packing with gelfoam needs to be standardized.

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All data are available within the manuscript and its supplemental files.

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Author notes

  1. Ebraheem Albazee and Ahmed Abu-Zaid have contributed equally to this work.

Authors and Affiliations

  1. Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait

    Ebraheem Albazee & Bader Alshammari

  2. College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

    Ahmed Abu-Zaid

  3. College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, 38163, USA

    Ahmed Abu-Zaid

  4. King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia

    Marzouqi Salamah & Abdulrahman Hagr

  5. Department of Otolaryngology, Aljouf University, Aljouf, Saudi Arabia

    Ahmed Naif Alolaywi

  6. Department of Otolaryngology-Head and Neck, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    Abdulaziz A. Almobarak

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  1. Ebraheem Albazee
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Contributions

EA and AA-Z contributed to study conception, literature review, data collection, data analysis, and manuscript writing. BA, ANA, and AAA contributed to literature review, data collection, data analysis, and revision of manuscript for editorial and intellectual contents. MS and AH contributed to study conception, study supervision, data interpretation, and revision of manuscript for editorial and intellectual contents. All authors read and approved the final draft of manuscript.

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Correspondence to Ahmed Abu-Zaid.

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405_2023_7975_MOESM1_ESM.docx

Supplemental Table 1. The exact literature search strategy used in every database. Supplemental Table 2. Summary of the GRADE rating of the outcomes. Supplementary file1 (DOCX 15 KB)

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Albazee, E., Abu-Zaid, A., Alshammari, B. et al. Efficacy of gelfoam middle ear packing in type-1 tympanoplasty: systematic review and meta-analysis. Eur Arch Otorhinolaryngol 280, 3503–3514 (2023). https://doi.org/10.1007/s00405-023-07975-1

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