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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.
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.,
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
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.
Laryngoscope 126: April 2016
Kerckhoffs et al.: A Review on Cholesteatoma Recidivism After CWU and CWD
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