HSC Section 8_April 2017

Fig. 1. Flowchart for study selection. Literature search performed on the 10th of December, 2014. After removal of duplicates, screening on title and abstract using the inclusion and exclusion criteria, screening on full-text and study assessment, 8 articles remained for critical appraisal. Legend: CINAHL 5 Cumulative Index to Nursing and Allied Health Literature; C(S)OM 5 chronic (suppurative) otitis media, CWD 5 canal wall down, CWU 5 canal wall up. *All inclusions and exclusions were made by consensus of at least two authors.

disease. 9 In the current review, we will use recidivism as a complete term for both residual and recurrent dis- ease. 10 We aim to identify which cholesteatoma removal technique, CWU or CWD surgery, results in the lowest rate of cholesteatoma recidivism in adult patients with a primary acquired cholesteatoma. We expect the CWD technique to have a lower cholesteatoma recidivism risk.

S.J.A.V.) (Fig. 1). Studies that compared residual and recurrent risks of both cholesteatoma removal techniques (CWU and CWD) in adult patients with primary cholesteatoma were selected. We excluded studies applying partly performed CWU techniques. 11 We reviewed references of included articles and used Scopus and Web of Science to apply a cross-reference check. Quality Assessment We constructed a critical appraisal tool (CAT) to verify the relevance and validity of included studies (Table I). A minimal of two authors (combination of K.G.P.K., M.B.J.K., S.J.A.V., T.H.L. V S.) appraised included studies. Relevance of determinant (CWU or CWD) was not assessed because all studies with an undefined determinant were excluded at the initial screening (title/abstract and full-text screening). We considered the follow- ing factors important during CAT screening: 1) definition of patients’ age, 2) reported length of follow-up and 3) distinction between residual and recurrent disease. Firstly, definition of age was important because the incidence of disease recidivism

MATERIALS AND METHODS Search Strategy

We conducted a search in the PubMed, Embase, Cochrane and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases on December 10th, 2014. Our search syntax is provided in the Appendix (available online only). Both title/ abstract and full-text screening were based on predefined inclu- sion and exclusion criteria and performed by a combination of at least two authors (combination of K.G.P.K., M.B.J.K., T.H.L. V S.,

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