HSC Section 8_April 2017

I. WEGNER ET AL.

TABLE 1.

Search strategy (date of last search: September 10, 2014)

CT for patients with otosclerosis). Studies were classified as having low relevance if two or more criteria were rated unsat- isfactory. Studies were classified as having moderate relevance if two criteria were rated satisfactory. The remaining studies were classified as having high relevance. Risk of bias was assessed by using predetermined criteria based on the Cochrane Collaboration’s tool for assessing risk of bias (11). Assessment of risk of bias involved the evaluation of six criteria. Studies were classified as having low risk of bias if five or more criteria were rated satisfactory and moderate risk of bias if at least three criteria were rated satisfactory. The remaining studies were classified as having a high risk of bias. Articles that were rated moderate or high for relevance and carried a low or moderate risk of bias were selected for further review. Initial discordances between reviewers (I.W. and A.v.W.) were again resolved by consensus discussion. Data Extraction Two authors (I.W. and A.v.W.) independently extracted descriptive data regarding the study population, the index test (CT), and the reference test (middle ear inspection and/or histopathology) from the included studies. The true positive, false positive, true negative, and false negative test results were extracted to calculate the prevalence, sensitivity, specificity, and post-test probabilities. The positive post-test probability represents the probability of the presence of otosclerosis in case of a positive CT. The negative post-test probability represents the probability of the presence of otosclerosis in case of a negative or normal CT. Positive and negative post-test proba- bilities were calculated using likelihood ratios (LRs) (12). Positive and negative LRs were calculated and subsequently used to calculate the post-test odds of otosclerosis. The odds were then translated to probabilities (12). Corresponding 95% confidence intervals (95% CIs) were calculated according to standard normal distribution (1.96 standard error). The method described by Monsour et al. (13) was used to calculate 95% CIs for post-test probabilities. Search and Selection The search yielded 1,575 unique articles. After screen- ing these articles on title and abstract and subsequently full text, 1,558 articles were excluded on the basis of the predefined inclusion and exclusion criteria (see Fig. 1 for the criteria). Of the 17 articles (2,3,6,14–27) that were considered eligible after full-text screening, another two were excluded on the basis of language (Japanese and Spanish) (14,15). The article by Marx et al. (16), and Lagleyre et al. (17) described the same study population, as well as the articles written by de Oliveira Vicente et al. in 2004 and 2006 (24,25). Reference checking did not result in any additional articles. Thus, in total 15 articles describing 13 studies were selected for study assessment (2,3,6,16–27). Study Assessment As shown in Table 2, two studies, described in three articles, were considered highly relevant (16–18). In the other 11 studies, patients with surgically confirmed oto- sclerosis were included in the study population instead of patients at risk of otosclerosis (2,3,6,19–27). The risk of RESULTS

Database

Search Strategy

Hits

1111

PubMed

((computertomography[tiab] OR tomogra- phy[tiab] OR CAT[tiab] OR CT[tiab] OR HRCT[tiab] OR CTscan[tiab] OR scan[tiab] OR imaging[tiab] OR radiologic[tiab] OR radiology[tiab]) AND (otoscler [tiab] OR otospong [tiab] OR stapes[tiab] OR stirrup[tiab] OR stapedial[tiab] OR ossicular[tiab] OR footplate[tiab] OR stapedot [tiab] OR stapedec [tiab] OR (middle AND ear AND inspection[tiab]))) OR ((tomography[MeSH Terms] OR scan[MeSH Terms]) AND (otoscler [MeSH Terms] OR stapes[MeSH Terms])) ((computertomography:ab,ti OR tomogra- phy:ab,ti OR cat:ab,ti OR ct:ab,ti OR hrct:ab,ti OR ctscan:ab,ti OR scan:ab,ti OR imaging:ab,ti OR radiologic:ab,ti OR radi- ology:ab,ti) AND (otoscler :ab,ti OR otospong :ab,ti OR stapes:ab,ti OR stirrup:ab,ti OR stapedial:ab,ti OR ossicular:ab,ti OR footplate:ab,ti OR stapedot :ab,ti OR stapedec :ab,ti OR (middle:ab,ti AND ear:ab,ti AND inspectio- n:ab,ti)) OR ((otosclerosis/exp OR stapes/ exp) AND tomography/exp)) AND [embase]/lim (((computertomography OR tomography OR CAT OR CT OR HRCT OR CTscan OR scan OR imaging OR radiologic OR radi- ology):ti,ab) AND ((otoscler OR otospong OR stapes OR stirrup OR stapedial OR ossicular OR footplate OR stapedot OR stapedec OR ‘middle ear inspection’):ti,ab)) OR (((otoscler OR stapes):kw) AND ((tom- ography OR scan):kw))

1098

Embase

8

The Cochrane Library

the criteria). Studies reporting original data on the diagnostic value of CT for the detection of otosclerosis in adult patients with a clinical suspicion of otosclerosis were included. System- atic reviews, opinion papers, non-human studies, and case reports with less than 10 cases were excluded. Studies that predominantly included pediatric patients were excluded. Articles written in languages other than English, Dutch, Ger- man, French, or Portuguese were excluded, as well as articles published before the year 2000. Subsequently, the full texts of eligible articles were independently screened by two reviewers per selected article (I.W., A.v.W., S.H.B., C.F.D, S.A.K., and M.R.). Additionally, PubMed and Web of Science were searched for related articles, and reference lists of the selected articles and systematic reviews on the topic were hand-searched for titles not identified by our initial search. Discordances regarding inclusion were solved by consensus discussion. Study Assessment The remaining articles were independently assessed for their relevance and risk of bias by two reviewers (I.W. and A.v.W.) using predefined criteria (see Table 2 for assessment criteria). A similar version of this system was previously used in other diagnostic systematic reviews (8–10). The criteria were classi- fied as ‘‘satisfactory’’ ( * ), or ‘‘unsatisfactory or unclear’’ ( * ). Relevance was scored to ensure that studies reported applicable outcomes for a well-defined patient group (diagnostic values of

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