Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 3 appraisals
Biomedical physics & engineering express
Simulation-driven deep learning for the diagnosis of middle ear pathologies using wideband acoustic immittance
Wideband acoustic immittance (WAI) provides comprehensive frequency-dependent information for diagnosing middle ear pathologies. However, the scarcity of clinical data and complex response patterns significantly hinder automated diagnosis, particularly in data-limited scenarios. To address this issue, this study proposes a simulation-driven computer-aided diagnosis framework for WAI based on finite element (FE) modeling. Latin hypercube sampling was employed to systematically perturb key physiological parameters of the human ear FE models, generating a standardized virtual WAI dataset comprising 12 000 samples across the 0.2-6 kHz frequency range. The dataset includes four middle ear conditions: normal ear, ossicular chain discontinuity, ossicular chain fixation, and otitis media with effusion. Based on this dataset, a lightweight convolutional neural network tailored for multi-channel WAI inputs, termed WAIHybrid, was developed. It was benchmarked against traditional feature-based machine learning models and five representative deep learning architectures on simulated data and subsequently evaluated on an external clinical dataset comprising 206 ear-level WAI records. WAIHybrid achieved a macro-F1 of 96.30% and a balanced accuracy of 96.29% on an independent simulated test set. On the external clinical dataset, the corresponding values were 87.76% and 88.07%, respectively. Response-level comparisons, learned-representation analyses, and Integrated Gradients maps identified partial class-related correspondence between the simulated and clinical data, residual simulation-to-clinical discrepancy, and class-dependent channel-frequency attribution patterns. These findings support a simulation-driven proof of concept for automated WAI analysis in data-limited middle ear assessment. Further evaluation in larger, more balanced, and clinically heterogeneous cohorts is needed.
19 July 2026
Read appraisal →International ophthalmology
Safety and efficacy of silicone intubation compared to standard techniques in endoscopic dacryocystorhinostomy: a systematic review and meta-analysis
BACKGROUND: Primary Acquired nasolacrimal duct obstruction (PANDO) is a lacrimal drainage disorder, commonly seen in adults. Endoscopic Dacryocystorhinostomy (EN-DCR) is a widely adopted surgical procedure for treatment of nasolacrimal duct obstruction. Silicon intubation is a technique, which involves inserting a soft silicone stent to keep the ostium patent post operatively. METHODS: This meta-analysis followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, with searches across 4 databases. Primary outcomes were overall success rate, and overall failure rate. Secondary outcomes included granulations/intracanalicular obstruction (ICO) threats, hemorrhage, anatomical failure, functional failure, recurrent symptoms/epiphora, and cicatricial stenosis/post-procedural restenosis. Data were analyzed using R software version 4.3. Heterogeneity was assessed using the I2 statistic. RESULTS: From 3,974 studies initially, 20 studies were selected in the final review, in which 17 were RCTs and 3 observational studies. A statistically significant improvement in surgical success rates, while reducing failure rates were observed in the silicone intubation (stented) group compared to the unstented group. No significant difference was observed in the incidence of restenosis, hemorrhage, functional failure, epiphora or recurrent symptoms. Reduction of anatomical failure was observed. Increase in adverse effects of granulation tissue formation and internal canalicular obstruction were observed. Heterogeneity was low and no publication bias was detected in outcomes. CONCLUSIONS: Silicone intubation during mechanical endoscopic dacryocystorhinostomy (EN-DCR) was associated with improved success and patency rates, as well as lower failure rate. While more resource-intensive, it provides a slightly higher advantage, particularly in recurrent or revision instances, recommending its implementation in routine EN-DCR where possible.
16 July 2026
Read appraisal →Diving and hyperbaric medicine
Evidence-informed decision aid for fitness-to-dive assessment after otologic surgery
INTRODUCTION: Fitness-to-dive after otologic surgery is often approached conservatively, with some procedures historically labelled as absolute contraindications despite limited empirical evidence. The available literature is heterogeneous and includes clinical reports, experimental pressure studies, guidance documents, and manufacturer specifications, leading to uncertainty in clinical counseling. We aimed to characterise the available evidence regarding fitness-to-dive after otologic surgery and to develop an evidence-informed clinical decision aid. METHODS: A scoping review was conducted in accordance with PRISMA-ScR guidance. PubMed/MEDLINE, Embase, Scopus, and relevant non-indexed sources were searched. Eligible sources included clinical reports and series, experimental or hyperbaric chamber studies, guidance or consensus documents, and manufacturer statements providing explicit pressure- or depth-related information. Data were charted descriptively by procedure type and evidence stream. RESULTS: The search identified 324 records; after removal of duplicates and screening, 40 sources were included. The evidence base was predominantly non-comparative. Across procedures, recommendations emphasised postoperative stability and reliable pressure equalisation rather than surgical history alone. Canal wall down mastoidectomy was consistently portrayed as incompatible with diving, whereas selected middle ear reconstructions and stapes surgery were commonly described as potentially compatible in appropriately selected individuals. For cochlear implantation, guidance was mainly conditional and based on hyperbaric testing, limited clinical diving reports, and manufacturer-specified pressure or depth limits. Communication emerged as an additional practical consideration in cases of significant hearing loss. CONCLUSIONS: Relevant evidence is limited and heterogeneous, and does not consistently support blanket prohibitions for all otologic procedures. A function-based, individualised approach is supported, while specific higher-risk scenarios warrant restriction. Prospective registries and standardised outcome reporting are needed to refine procedure-specific recommendations.
30 June 2026
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