xRead - January 2023

Fig. 4. Forest plot depicting rate of restenosis at short-term (A) and long-term (B) follow-up. CI 5 confidence interval. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]

from 36% to 12%, and failures (ABG > 30 dB) increased from 10% to 24% over that time period. 7 Furthermore, in a more recent retrospective review by Ghani and Smith, the authors showed that mean ABG decreased from 29.9 dB preoperatively to 12 dB within 6 months of surgery; however, ABG was noted to increase again to a mean 19 dB for patients followed for > 5 years. 10 These studies, along with our own, collectively support the excellent short-term hearing results for patients treated surgically for PIMCF but underscore the risk of late dis ease recurrence. Clinical Outcomes As a primary clinical outcome, rates of short- and long-term restenosis were assessed in our cohort and among the systematic review articles. Within our cohort, there was a single case of complete restenosis (7.1%), which occurred at long-term follow-up. The meta analysis revealed short- and long-term restenosis rates of 8.0% and 13.8%, respectively. Perhaps more impor tantly, however, our rate of late partial or complete

declines in hearing noted over time in the pooled analy sis. This analysis revealed a significantly diminishing achievement of ABG 10 dB and 20 dB over time ( P < 0.010 and P 5 0.037, respectively) (Fig. 3). Although, our cohort data showed similar trends, significance was not attained, likely attributable to it being a lesser powered analysis. These findings are not surprising because they are likely directly related to and consistent with the relatively high rate of partial restenosis and recurrent inflammatory EAC disease that occurs among these patients with time. Few other studies have compared short- and long term audiometric outcomes in the surgical management of PIMCF; however, those that have show similar trends in favorable early audiometric outcomes that diminish over time. Becker and Tos were the first to compare short- and long-term outcomes in this subset of patients and showed 90% achievement of ABG 20 dB at early follow-up, but this benefit decreased to only 61% of patients after 2 years. 13 In 2009, Magliulo reviewed his outcomes within 12 months of surgery and at 5 years and showed that achievement of ABG 10 dB decreased

Laryngoscope 127: February 2017

Keller et al.: Retrospective Review and Meta-Analysis

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