Mastoid Obliteration Using Granules of S53p4 Bioactive Glass: Systematic Review and Meta‐Analysis

OBJECTIVE: This study used a systematic review and meta-analysis to evaluate the tolerance and rate of postoperative complications associated with using granules of S53P4 bioactive glass (BAG) for mastoid obliteration surgeries. DATA SOURCES: A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. REVIEW METHODS: This systematic review and meta-analysis was performed according to the PRISMA statement. Data from eligible studies were extracted and used to calculate the pooled rate of postoperative complications and pooled audiologic outcomes. RESULTS: A total of 12 studies (583 patients; 54.1% males; median age 41.6 years) was included. The mean follow-up was 28.8 months (95% CI: 18.5-39.1). We found a pooled complication rate of 16% of patients (n = 542; 95% CI: 0.11-0.22) for postoperative transient or persistent otorrhea, 2% (n = 529; 95% CI: 0.01-0.05) for surgical wound infection and 1% (n = 570; 95% CI: 0.01-0.03) for extrusion of BAG granules into the external auditory canal. The pooled rate was 6% (n = 239, 95% CI: 0.01-0.30) for Merchant grade 2 or 3 at last follow-up, indicating persistent or uncontrolled otorrhea. Pooled audiologic outcomes revealed that bone conduction remained stable between the preoperative and postoperative setting. CONCLUSIONS: S53P4 BAG granules seem a safe material for mastoid obliteration, with a low rate of postoperative complications and good inner-ear tolerance. Further multicenter prospective studies are warranted to confirm these findings.