Abstract
This is a letter to the editor enlisting a few concerns and points of view which arose on reading a recently published article on the novel use of platelet rich fibrin membrane in transcanal myringoplasty.
Keywords: Myringoplasty, Platelet-rich fibrin, Otitis media, Suppurative
Dear editor,
We read the recently published article by Shukla et al. with great interest [1]. The authors have presented a prospective cohort of patients who underwent myringoplasty with the novel use of platelet-rich fibrin membrane. In this attempt, the authors have assessed improvement in hearing, as one of the secondary objectives of the study. They have reported a significant improvement in hearing thresholds with p value of < 0.001.
Firstly, the decided parameter for comparison between the pre-operative and post-operative hearing levels was the air-bone gap (ABG) of the affected ear. However, the authors have not depicted the absolute values in the results. To our knowledge and interest, a table depicting the pre- and post-operative ABGs of only the operated ears, followed by the estimate of difference in between the two groups of ABGs, and an estimate of the significance level of this difference, would be justified. A lack of clarity in the test of significance used to compare the data, throughout the article, makes us propose the use of paired t test or Wilcoxon Signed Rank test, depending on the type of distribution of the data, for comparing the pre- and post-operative ABGs. The direction of change can be estimated by looking at the mean (standard deviation) or median (inter-quartile range) depending on the normal or non-normal distribution of data.
Secondly, an explanation in the text is lacking, for a total of 38 right ears undergoing pure tone audiometry in pre-operative period as compared to 41 right ears evaluated post-operatively and 41 left ears in pre- and post-operative period, as described in results.
Thirdly, while the follow-up of patients was routinely scheduled at 1 month post-operatively, authors have described the status of the operated ears after 2 weeks of undergoing the procedure. The primary endpoint for evaluation of success of graft was found to be not earlier than 3 weeks in most studies [2–4]. Two weeks is deemed quite early for determining the post-operative outcome of the procedure, as the coming few weeks might reveal more patients with complications.
Lastly, it would be interesting to the readers to know to what extent does deviated nasal septum and tonsillar hypertrophy affect the outcome of the procedure as it is discussed in the article but again, data for it is lacking in results.
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Footnotes
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Contributor Information
Dhruv Kapoor, Email: dkapooralld@gmail.com.
Henam Mona, Email: mona.henam.0503@gmail.com.
Neelima Gupta, Email: write2drneelima@yahoo.com.
References
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