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Punch vs open surgical techniques for placement of bone-anchored hearing implants: a systematic review and meta-analysis of skin reactions and operating time

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Abstract

Purpose

Several authors have reported their experience with the punch technique as compared to open surgical methods for bone-anchored hearing implants (BAHI). However, no study has attempted to aggregate current evidence. We aimed to compare post-operative skin complications and operating time between punch and open surgical techniques of BAHI via a systematic review and meta-analysis.

Methods

Databases of PubMed, Embase, Scopus, BioMed Central, Ovoid, and CENTRAL were screened up to 15th February 2020 to include studies comparing punch and open surgical technique for BAHI.

Results

Eight studies were included. Punch technique was compared with dermatome and linear incision techniques with and without soft tissue reduction. There was no difference in normal-to-moderate skin reaction between the punch and open surgical techniques (OR: 0.86 95% CI 0.23, 3.28 I2 = 0%). The incidence of adverse skin reactions were also not different between the two groups. Meta-regression for different follow-up periods did not demonstrate any statistically significant results. Our results also indicated that punch technique requires less operating time, however, the inter-study heterogeneity in the analysis was very high. Similar results were seen on sub-group analysis based on the type of open surgical technique.

Conclusion

There may be no difference in skin tolerance between the punch technique and open surgical techniques. Operating time may be significantly reduced with the punch technique. Strong conclusions cannot be drawn owing to a limited number of studies. Further large-scale randomized trials are required.

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Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Nursing, Hunan Provincial People’s Hospital, the First-Affiliated Hospital of Hunan Normal University, 61 Jiefang West Road, Changsha, Hunan, China

    Qianyu **ao, Fanghua Gong & Weihua Hu

  2. Department of ENT & HN Surgery, Hunan Provincial People’s Hospital, the First-Affiliated Hospital of Hunan Normal University, Changsha, China

    Ning Wang

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  1. Qianyu **ao
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  2. Fanghua Gong
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  3. Ning Wang
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  4. Weihua Hu
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Contributions

QX conceived and designed the study. FG, NW and WH collected the data and performed the literature search. QX was involved in the writing of the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Qianyu **ao.

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Supplementary Information

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Search strategy and PubMed search results (DOCX 16 KB)

Risk of bias in included studies (DOCX 16 KB)

405_2020_6511_MOESM3_ESM.tiff

Meta-regression of follow-up period in months on logarithmic odds ratio for normal to moderate skin reaction after punch vs open surgical techniques for BAHI (TIFF 17580 KB)

405_2020_6511_MOESM4_ESM.tiff

Meta-regression of follow-up period in months on logarithmic odds ratio for adverse skin reaction after punch vs open surgical techniques for BAHI (TIFF 17580 KB)

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**ao, Q., Gong, F., Wang, N. et al. Punch vs open surgical techniques for placement of bone-anchored hearing implants: a systematic review and meta-analysis of skin reactions and operating time. Eur Arch Otorhinolaryngol 278, 3171–3180 (2021). https://doi.org/10.1007/s00405-020-06511-9

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  • DOI: https://doi.org/10.1007/s00405-020-06511-9

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