Efficacy of Multiple Interventions for Moderate to Large Traumatic Tympanic Membrane Perforations: A Systematic Review and Network Meta-Analysis

IF 1.9 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology Pub Date : 2026-08-03 Epub Date: 2026-05-25 DOI:10.1111/coa.70121

Yueyue Cai, Rui Lai, Tingting Zhu, Qiang Li

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引用次数: 0

Abstract

Objective

This study aimed to evaluate the comparative efficacy of various therapeutic interventions for moderate to large traumatic tympanic membrane perforations (TTMP) through a network meta-analysis. Different treatment strategies were compared with respect to tympanic membrane healing rate, healing time, hearing improvement and incidence of otorrhea, providing evidence-based support for clinical decision-making.

Methods

A systematic search of multiple databases, including PubMed, Web of Science and Embase, was conducted to identify randomised controlled trials (RCTs) involving patients with moderate to large TTMP. A Bayesian hierarchical model was utilised to perform the network meta-analysis, assessing the relative effects of different interventions. Effect sizes, including relative risk (RR) and mean difference (MD), were computed for each intervention, with all analyses reported alongside 95% confidence intervals (CIs).

Results

A total of 13 studies involving 1285 patients were included in the analysis. The findings suggested that fibroblast growth factor-2 (FGF-2) demonstrated the highest efficacy in enhancing tympanic membrane healing rates and reducing healing times, particularly when combined with gelfoam patching. Additionally, ofloxacin otic solution appeared to have positive effects on healing rates. Conversely, edge approximation ranked lowest among all interventions, suggesting limited effectiveness in treating moderate to large perforations.

Conclusion

This network meta-analysis provides hypothesis-generating evidence that active intervention may be superior to watchful waiting for moderate to large TTMPs. FGF-2-based strategies, particularly when combined with physical scaffolds, show promise in improving healing outcomes. Additionally, ofloxacin otic solution may offer benefits in controlling local infections and optimising the middle ear microenvironment. In contrast, edge approximation appears less effective in this population. However, given the geographic homogeneity, limited number of studies and methodological constraints, these findings should be considered exploratory and require confirmation in large-scale, multicentre RCTs with standardised protocols and robust blinding procedures.

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多种干预措施对中大型外伤性鼓膜穿孔的疗效：系统回顾和网络荟萃分析。

目的：本研究旨在通过网络荟萃分析，评估各种治疗干预措施对中大型外伤性鼓膜穿孔（TTMP）的比较疗效。比较不同治疗策略对鼓膜愈合率、愈合时间、听力改善及耳漏发生率的影响，为临床决策提供循证支持。方法：系统检索多个数据库，包括PubMed、Web of Science和Embase，以确定涉及中度至重度TTMP患者的随机对照试验（RCTs）。采用贝叶斯层次模型进行网络元分析，评估不同干预措施的相对效果。计算每种干预措施的效应大小，包括相对风险（RR）和平均差异（MD），所有分析报告均附有95%置信区间（ci）。结果：共纳入13项研究，涉及1285例患者。研究结果表明，成纤维细胞生长因子-2 （FGF-2）在提高鼓膜愈合率和缩短愈合时间方面表现出最高的功效，特别是当与明胶泡沫贴片结合使用时。此外，氧氟沙星溶液似乎对治愈率有积极的影响。相反，边缘近似在所有干预措施中排名最低，表明治疗中大型穿孔的效果有限。结论：该网络荟萃分析提供了假设生成证据，表明积极干预可能优于观察等待中度至大型ttmp。基于fgf -2的策略，特别是与物理支架结合时，有望改善愈合结果。此外，氧氟沙星溶液可能具有控制局部感染和优化中耳微环境的作用。相反，边缘近似在这个种群中显得不那么有效。然而，考虑到地理上的同质性、有限的研究数量和方法上的限制，这些发现应该被认为是探索性的，需要在大规模、多中心的随机对照试验中进行确认，并采用标准化的方案和健全的盲法程序。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Otolaryngology 医学-耳鼻喉科学

CiteScore

4.00

自引率

4.80%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with: current otorhinolaryngological practice audiology, otology, balance, rhinology, larynx, voice and paediatric ORL head and neck oncology head and neck plastic and reconstructive surgery continuing medical education and ORL training The emphasis is on high quality new work in the clinical field and on fresh, original research. Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject. • Negative/null results In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.