Response to “Laser versus conventional fenestration in stapedotomy for otosclerosis: a systematic review”.
Van Rompaey Vincent, MD, PhD1,2 Van de Heyning Paul, MD, PhD1,2
1
Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University
Hospital, Edegem, Belgium. 2
Faculty of Medicine and Health Sciences, Campus Drie Eiken, University of
Antwerp, Antwerp, Belgium. Corresponding author Vincent Van Rompaey, MD, PhD Dept. of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium [email protected]
Requests for reprints should be sent to this address. None of the authors have financial interests in relation to this work. No financial support was provided toward the completion of this work. Conflict of interest: None. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/lary.24627 The American Laryngological, Rhinological and Otological Society, Inc.
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The Laryngoscope
To the Editor In the article “Laser versus conventional fenestration in stapedotomy for otosclerosis: a systematic review.” (1), Wegner et al. have reported a systematic review assessing hearing outcome and complications following primary stapedotomy in otosclerosis patients. We thank the authors for their effort in producing this work concentrating on an important clinical issue. There are, however, a few comments we would like to present. Firstly, the authors report to have studied sensorineural hearing loss (SNHL), but a relevant definition is lacking. The AAO-HNS guidelines (2) have defined SNHL as an increase in bone conduction (BC) pure-tone average (PTA) of 1, 2 and 4 kHz. When taking a closer look into the methods section of the 8 shortlisted articles, none are reporting postoperative SNHL in compliance with these guidelines. In fact, 7 different types of BC reporting can be observed (table 1, references in original article). Only 2 reports have used the same PTA, explained by the fact that they were submitted by the same group. (3,4) Moreover, the study inclusion periods in the latter reports are overlapping: 1998-2001 and 1996-2000 respectively. Therefore, bias due to duplicate data cannot be excluded. The readers should at least be informed of this kind of heterogeneity to draw their conclusion based on raw data, e.g. by providing the qualitative analysis as supplementary digital content. (5) Secondly, we have observed that not every eligible study was included by the authors. Although we haven’t repeated the systematic review process per se, we have noticed at least one prospective study, reported by our group (6), that was nor included nor shortlisted. In this study laser and conventional techniques were compared while hearing outcome reporting was fully complying with the relevant guidelines. No statistically significant difference (SSD) was observed in SNHL at 3 months reported
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The Laryngoscope
Page 4 of 6
as percentage of 1, 2 and 4 kHz BC PTA over 15 dBHL. However, we observed a SSD in BC PTA difference favouring conventional techniques (i.e. 5 dBHL overclosure in conventional techniques and 1.25 dBHL when using the laser). Based on the abovementioned arguments, we do not agree with the authors’ second conclusion that laser should be preferred over conventional techniques because of less SNHL. At least one relevant study was excluded unduly, which might suggest the opposite. The authors’ first conclusion, i.e. both techniques are equivalent, is reasonable but outcome reporting demonstrates a considerable heterogeneity.
The American Laryngological, Rhinological and Otological Society, Inc.
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Page 5 of 6
The Laryngoscope
Tables Table 1. Bone conduction pure-tone averages Häusler
250-2.000 Hz, 4.000 Hz
Badran
500, 1.000, 2.000 Hz
Barbara
250, 2.000 Hz
Moscillo
500, 1.000, 2.000, 3.000 Hz
Matkovic
250, 500, 1.000, 4.000 Hz
Motta
500, 1.000, 2.000, 3.000 Hz
Just
Population average of individual thresholds 250, 500, 1.000, 2.000, 3.000, 4.000, 6.000, 8.000 Hz
Cuda
500, 1.000, 2.000, 4.000 Hz
The American Laryngological, Rhinological and Otological Society, Inc.
5
The Laryngoscope
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References 1. Wegner I, Kamalski DM, Tange RA, et al. Laser versus conventional fenestration in stapedotomy for otosclerosis: A systematic review. Laryngoscope. 2013 Nov 11. doi: 10.1002/lary.24514. [Epub ahead of print]. 2. Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. American Academy of OtolaryngologyVHead and Neck Surgery Foundation, Inc. Otolaryngol Head Neck Surg. 1995;113:186Y7. 3. Moscillo L, Imperiali M, Carra P, Catapano F, Motta G. Bone conduction variation poststapedotomy. Am J Otolaryngol. 2006;27:330-3. 4. Motta G, Moscillo L. Functional results in stapedotomy with and without CO(2) laser. ORL J Otorhinolaryngol Relat Spec. 2002;64:307-10. 5. Van Rompaey V, Claes G, Potvin J, Wouters K, Van de Heyning PH. Systematic Review of the Literature on Nitinol Prostheses in Surgery for Otosclerosis: Assessment of the Adequacy of Statistical Power. Otol Neurotol. 2011;32:357-366. 6. Van Rompaey V, Yung M, Claes J, et al. Prospective Effectiveness of Stapes Surgery for Otosclerosis in a Multicenter Audit Setting: Feasibility of the Common Otology Database as a Benchmark Database. Otol Neurotol. 2009;30:1101-1110.
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6
Van Rompaey Vincent, MD, PhD1,2 Van de Heyning Paul, MD, PhD1,2
1
Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University
Hospital, Edegem, Belgium. 2
Faculty of Medicine and Health Sciences, Campus Drie Eiken, University of
Antwerp, Antwerp, Belgium. Corresponding author Vincent Van Rompaey, MD, PhD Dept. of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium [email protected]
Requests for reprints should be sent to this address. None of the authors have financial interests in relation to this work. No financial support was provided toward the completion of this work. Conflict of interest: None. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/lary.24627 The American Laryngological, Rhinological and Otological Society, Inc.
Page 3 of 6
The Laryngoscope
To the Editor In the article “Laser versus conventional fenestration in stapedotomy for otosclerosis: a systematic review.” (1), Wegner et al. have reported a systematic review assessing hearing outcome and complications following primary stapedotomy in otosclerosis patients. We thank the authors for their effort in producing this work concentrating on an important clinical issue. There are, however, a few comments we would like to present. Firstly, the authors report to have studied sensorineural hearing loss (SNHL), but a relevant definition is lacking. The AAO-HNS guidelines (2) have defined SNHL as an increase in bone conduction (BC) pure-tone average (PTA) of 1, 2 and 4 kHz. When taking a closer look into the methods section of the 8 shortlisted articles, none are reporting postoperative SNHL in compliance with these guidelines. In fact, 7 different types of BC reporting can be observed (table 1, references in original article). Only 2 reports have used the same PTA, explained by the fact that they were submitted by the same group. (3,4) Moreover, the study inclusion periods in the latter reports are overlapping: 1998-2001 and 1996-2000 respectively. Therefore, bias due to duplicate data cannot be excluded. The readers should at least be informed of this kind of heterogeneity to draw their conclusion based on raw data, e.g. by providing the qualitative analysis as supplementary digital content. (5) Secondly, we have observed that not every eligible study was included by the authors. Although we haven’t repeated the systematic review process per se, we have noticed at least one prospective study, reported by our group (6), that was nor included nor shortlisted. In this study laser and conventional techniques were compared while hearing outcome reporting was fully complying with the relevant guidelines. No statistically significant difference (SSD) was observed in SNHL at 3 months reported
The American Laryngological, Rhinological and Otological Society, Inc.
3
The Laryngoscope
Page 4 of 6
as percentage of 1, 2 and 4 kHz BC PTA over 15 dBHL. However, we observed a SSD in BC PTA difference favouring conventional techniques (i.e. 5 dBHL overclosure in conventional techniques and 1.25 dBHL when using the laser). Based on the abovementioned arguments, we do not agree with the authors’ second conclusion that laser should be preferred over conventional techniques because of less SNHL. At least one relevant study was excluded unduly, which might suggest the opposite. The authors’ first conclusion, i.e. both techniques are equivalent, is reasonable but outcome reporting demonstrates a considerable heterogeneity.
The American Laryngological, Rhinological and Otological Society, Inc.
4
Page 5 of 6
The Laryngoscope
Tables Table 1. Bone conduction pure-tone averages Häusler
250-2.000 Hz, 4.000 Hz
Badran
500, 1.000, 2.000 Hz
Barbara
250, 2.000 Hz
Moscillo
500, 1.000, 2.000, 3.000 Hz
Matkovic
250, 500, 1.000, 4.000 Hz
Motta
500, 1.000, 2.000, 3.000 Hz
Just
Population average of individual thresholds 250, 500, 1.000, 2.000, 3.000, 4.000, 6.000, 8.000 Hz
Cuda
500, 1.000, 2.000, 4.000 Hz
The American Laryngological, Rhinological and Otological Society, Inc.
5
The Laryngoscope
Page 6 of 6
References 1. Wegner I, Kamalski DM, Tange RA, et al. Laser versus conventional fenestration in stapedotomy for otosclerosis: A systematic review. Laryngoscope. 2013 Nov 11. doi: 10.1002/lary.24514. [Epub ahead of print]. 2. Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. American Academy of OtolaryngologyVHead and Neck Surgery Foundation, Inc. Otolaryngol Head Neck Surg. 1995;113:186Y7. 3. Moscillo L, Imperiali M, Carra P, Catapano F, Motta G. Bone conduction variation poststapedotomy. Am J Otolaryngol. 2006;27:330-3. 4. Motta G, Moscillo L. Functional results in stapedotomy with and without CO(2) laser. ORL J Otorhinolaryngol Relat Spec. 2002;64:307-10. 5. Van Rompaey V, Claes G, Potvin J, Wouters K, Van de Heyning PH. Systematic Review of the Literature on Nitinol Prostheses in Surgery for Otosclerosis: Assessment of the Adequacy of Statistical Power. Otol Neurotol. 2011;32:357-366. 6. Van Rompaey V, Yung M, Claes J, et al. Prospective Effectiveness of Stapes Surgery for Otosclerosis in a Multicenter Audit Setting: Feasibility of the Common Otology Database as a Benchmark Database. Otol Neurotol. 2009;30:1101-1110.
The American Laryngological, Rhinological and Otological Society, Inc.
6
