Comparative efficacy of tympanostomy tube insertion for secretory otitis media following radiotherapy for head and neck malignancies: a network meta-analysis

BACKGROUND: There is no consensus regarding the optimal management of postradiation secretory otitis media (SOM) in patients with head and neck malignancies. OBJECTIVES: In this network meta-analysis, we compared the efficacy and complication profiles of tympanostomy tube insertion (TI), laser tympanostomy (LT), tympanocentesis (TC), intratympanic injection (ITI), and TI combined with injection (TI+I). METHODS: Sixteen studies (nine randomized controlled trials [RCTs] and seven semi-RCTs; 1464 participants) were analyzed using Stata 15.0. Primary outcomes included treatment efficacy based on the Surface Under the Cumulative Ranking Curve (SUCRA) and complication rates, specifically suppurative otitis media and tympanic membrane perforation. RESULTS: Efficacy rankings were as follows: ITI < TC < TI < TI+I < LT, with SUCRA values highest for LT (97.3%) and TI+I (71.3%). LT and TI+I showed greater symptom relief and hearing improvement than the other interventions. Complication rates were the lowest for LT (suppurative otitis: 13.2%; tympanic perforation: 14.2%) and the highest for ITI (77.3% and 70.4%, respectively). TI performed with preinsertion ambroxol or triamcinolone was associated with a reduced recurrence rate. CONCLUSIONS: Laser tympanostomy offers optimal efficacy and safety for postradiation SOM, with TI+I representing a feasible alternative. ITI and TC were associated with higher complication risks. Key limitations include short follow-up duration for LT and the predominance of unblinded study designs.