Vertiginous Episodes in Menière Disease following Transmyringeal Ventilation Tube Insertion: A Systematic Review on the Current State of Evidence

Grønlund, Casper; Devantier, Louise; Edemann-Callesen, Henriette; Hougaard, Dan Dupont; Händel, Mina Nicole; Schmidt, Jesper Hvass; Guldfred, Frank Liviu-Adelin; Djurhuus, Bjarki Ditlev

doi:10.1055/s-0040-1714131

Cited by 3 publications

(2 citation statements)

References 31 publications

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“…We identified two further reviews that also included only these two RCTs (Devantier 2019;Lim 2015). We also identified two reviews that included non-randomised studies (Ballard 2019;Gronlund 2021), therefore cannot be easily compared with our own review. However, despite the slightly di erent approaches taken by other authors, we are in agreement with their general conclusions -that there is a paucity of evidence for these interventions, and there is a need for high-quality RCTs in this area.…”

Section: Librarymentioning

confidence: 99%

Surgical interventions for Ménière’s disease

Webster

Harrington-Benton²,

Judd

et al. 2021

Cochrane Database of Systematic Reviews

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Cochrane Database of Systematic Reviews adverse events. Our secondary outcomes were: 4) disease-specific health-related quality of life, 5) change in hearing, 6) change in tinnitus and 7) other adverse e ects. We considered outcomes reported at three time points: 3 to < 6 months, 6 to ≤ 12 months and > 12 months. We used GRADE to assess the certainty of evidence for each outcome. Main resultsWe included two studies with a total of 178 participants. One evaluated ventilation tubes compared to no treatment, the other evaluated endolymphatic sac decompression compared to sham surgery. Ventilation tubesWe included a single RCT of 148 participants with definite Ménière's disease. It was conducted in a single centre in Japan from 2010 to 2013. Participants either received ventilation tubes with standard medical treatment, or standard medical treatment alone, and were followed up for two years. Some data were reported on the number of participants in whom vertigo resolved, and the e ect of the intervention on hearing. Our other primary and secondary outcomes were not reported in this study. This is a single, small study and for all outcomes the certainty of evidence was low or very low. We are unable to draw meaningful conclusions from the numerical results. Endolymphatic sac decompressionWe also included one RCT of 30 participants that compared endolymphatic sac decompression with sham surgery. This was a single-centre study conducted in Denmark during the 1980s. Follow-up was predominantly conducted at one year, but additional follow-up continued for up to nine years in some participants. Some data were reported on hearing and vertigo (both improvement in vertigo and change in vertigo), but our other outcomes of interest were not reported. Again, this is a single, very small study and we rated the certainty of the evidence as very low for all outcomes. We are therefore unable to draw meaningful conclusions from the numerical results. Authors' conclusionsWe are unable to draw clear conclusions about the e icacy of these surgical interventions for Ménière's disease. We identified evidence for only two of our five proposed comparisons, and we assessed all the evidence as low-or very low-certainty. This means that we have very low confidence that the e ects reported are accurate estimates of the true e ect of these interventions. Many of the outcomes that we planned to assess were not reported by the studies, such as the impact on quality of life, and adverse e ects of the interventions. Consensus on the appropriate outcomes to measure in studies of Ménière's disease is needed (i.e. a core outcome set) in order to guide future studies in this area and enable meta-analyses of the results. This must include appropriate consideration of the potential harms of treatment, as well as the benefits.

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Section: Librarymentioning

confidence: 99%

Surgical interventions for Ménière’s disease

Webster

Harrington-Benton²,

Judd

et al. 2021

Cochrane Database of Systematic Reviews

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“…The methodology used in the Danish Health Authority guideline development has previously been described [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. In short, the methodology is based on the recommendations for conducting systematic reviews and meta-analyses from the Cochrane Handbook for systematic reviews [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Cochrane Reviews in Clinical Guideline Development—A Survey of 585 Recommendations

Korfitsen

Mikkelsen

Ussing

et al. 2022

IJERPH

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The Danish Health Authority develops clinical practice guidelines to support clinical decision-making based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and prioritizes using Cochrane reviews. The objective of this study was to explore the usefulness of Cochrane reviews as a source of evidence in the development of clinical recommendations. Evidence-based recommendations in guidelines published by the Danish Health Authority between 2014 and 2021 were reviewed. For each recommendation, it was noted if and how Cochrane reviews were utilized. In total, 374 evidence-based recommendations and 211 expert consensus recommendations were published between 2014 and 2021. Of the 374 evidence-based recommendations, 106 included evidence from Cochrane reviews. In 28 recommendations, all critical and important outcomes included evidence from Cochrane reviews. In 36 recommendations, a minimum of all critical outcomes included evidence from Cochrane reviews, but not all important outcomes. In 33 recommendations, some but not all critical outcomes included evidence from Cochrane reviews. Finally, in nine recommendations, some of the important outcomes included evidence from Cochrane reviews. In almost one-third of the evidence-based recommendations, Cochrane reviews were used to inform clinical recommendations. This evaluation should inform future evaluations of Cochrane review uptake in clinical practice guidelines concerning outcomes important for clinical decision-making.

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