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PORP vs. TORP in children: A systematic review and meta-analysis
Mahmoud Omar1, Jennifer L McCoy2, Dennis J Kitsko3
1University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
Insights
Pediatric partial ossicular reconstruction prostheses (PORPs) offer better hearing outcomes than total ossicular reconstruction prostheses (TORPs). This systematic review found PORP recipients had lower pre-operative and post-operative air-bone gaps (ABGs) with similar extrusion rates.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Surgical Outcomes
Background:
- Ossicular reconstruction is a common surgical procedure for hearing restoration in children.
- Partial ossicular reconstruction prostheses (PORPs) and total ossicular reconstruction prostheses (TORPs) are used, but their comparative effectiveness in pediatric populations is not fully elucidated.
Approach:
- A systematic review and meta-analysis of quantitative studies was performed, last updated September 29, 2021.
- Databases searched included PubMed, Scopus, and Embase for studies involving pediatric patients (0-18 years) undergoing PORP or TORP procedures.
- Studies were assessed for risk of bias using the NIH Quality Assessment Tool, and data were analyzed using Review Manager (RevMan) version 5.4.1.
Key Points:
- Data from 449 children (202 PORP, 247 TORP recipients) were analyzed.
- PORP recipients showed significantly better pre-operative (mean difference -6.30 dB) and post-operative air-bone gaps (ABG) (mean difference -1.80 dB) compared to TORP recipients.
- PORP recipients were more likely to achieve a successful post-operative ABG ≤20 dB (OR: 2.12), with no significant difference in extrusion rates between PORP and TORP.
Conclusions:
- Pediatric patients receiving PORPs demonstrate superior pre-operative hearing baselines and post-operative hearing results compared to those receiving TORPs.
- Extrusion rates are comparable between PORP and TORP procedures in pediatric populations.
- Further research is needed, with detailed reporting of surgical specifics, to enhance future meta-analyses on pediatric ossicular reconstruction outcomes.
Objectives:
To compare the mean pre-operative air-bone gaps (ABG), mean post-operative ABGs, and extrusion rates between pediatric recipients of partial ossicular reconstruction prostheses (PORPs) and pediatric recipients of total ossicular reconstruction prostheses (TORPs) via a systematic review and meta-analysis.
Methods:
A quantitative systematic review last updated on September 29, 2021 of PubMed, Scopus, and Embase databases was conducted for studies reporting mean post-operative ABGs or numbers of children with post-operative ABG ≤ 20 dB following PORP and TORP procedures in at least five children aged 0-18 years. Studies were excluded if they were review articles, conference abstracts, or not in English. Studies that primarily reported data on congenital aural atresia, stapedectomy/stapedotomy, congenital stapes fixation, or juvenile otosclerosis were also excluded. NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess for risk of bias. Review Manager (RevMan) version 5.4.1 was used to perform the meta-analysis and generate forest plots.
Results:
Out of 648 unique abstracts retrieved, 11 papers were included in this systematic review with meta-analysis. Data from 449 children (247 TORP recipients and 202 TORP recipients) are represented among the various analyses. Data from nine studies, representing 84.2 % of all children in the systematic review, demonstrated that PORP recipients presented with a pre-operative ABG 6.30 dB less than TORP recipients (mean difference: -6.30, 95 %CI: -7.4, -5.18, p < 0.01). Data from these same children demonstrated that PORP recipients had a 1.80 dB less post-operative ABG compared to TORP recipients (mean difference: -1.80 dB, 95 %CI: -2.84, -0.77, p < 0.001). Data from seven studies, representing 49.4 % of all children in the systematic review, demonstrated that PORP recipients were more likely to have a successful closure of the post-operative ABG to ≤20 dB (OR: 2.12, 95 %CI: 1.18, 3.79, p = 0.01). In these same children, 62.5 % of PORP recipients had a post-operative ABG ≤ 20 dB and 48.3 % of TORP recipients had a post-operative ABG ≤ 20 dB. There was no difference in extrusion rates between PORP recipients compared to TORP recipients (OR: 1.08, 95 %CI: 0.31, 3.78, p = 0.90) from five studies representing 45.9 % children in the systematic review.
Conclusion:
Children who receive a PORP have better pre-operative hearing baselines and post-operative hearing outcomes compared to those who receive TORP with similar rates of extrusion. More pediatric studies should report their mean pre- and post-operative ABGs stratifying by various material types, surgical indications, and surgical details to facilitate future meta-analyses.
