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Underlay Myringoplasty Versus Overlay Myringoplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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Abstract

Myringoplasty is still the most performed otological surgery. Nevertheless, the underlay vs. overlay approaches have yet to be determined. The purpose of this study is to compare the surgical and audiological outcomes of underlay and overlay myringoplasty in perforated tympanic membrane patients. A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching of Web of Science, SCOPUS, PubMed, and Google Scholar until January 25th, 2023. RevMan version 5.4 software was used to pooled dichotomous outcomes using the risk ratio (RR) with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: [CRD42023387432]. We included eight RCTs with 656 tympanic perforation membrane patients. Four RCTs had a low risk of overall bias, two had some concerns, and two had a high risk of bias. The underlay technique was significantly associated with a higher surgical success rate (n = 7 RCTs, RR: 1.21 with 95% CI [1.02, 1.43],  P = 0.03) and audiological success rate (n = 4 RCTs, RR: 1.31 with 95% CI [1.18, 1.44], P < 0.00001). This meta-analysis underscores the potential superiority of the underlay technique in managing tympanic membrane perforations, with significant implications for surgical and audiological outcomes. However, more investigations are still necessary to confirm this result.

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Data Availability

All data are available within the manuscript and can be obtained from the corresponding author upon a reasonable request.

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Acknowledgements

The authors would like to thank Omar Abdalwahab for his valuable assistant.

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Authors and Affiliations

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

    Ebraheem Albazee & Mubarak Althaidy

  2. 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

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  1. Ebraheem Albazee
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Contributions

EA contributed to study conception, study design, data collection, data analysis, write up of original draft of manuscript, and review of manuscript for editorial and intellectual contents. MS, and MA contributed to literature review, data collection, and review of manuscript for editorial and intellectual contents. AH contributed to supervision and review of manuscript for editorial and intellectual contents. All authors read and approved the final draft of manuscript.

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Correspondence to Ebraheem Albazee.

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Albazee, E., Salamah, M., Althaidy, M. et al. Underlay Myringoplasty Versus Overlay Myringoplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Indian J Otolaryngol Head Neck Surg 76, 1848–1856 (2024). https://doi.org/10.1007/s12070-023-04425-6

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