A Systematic Review of Eustachian Tube Procedures for Baro‐challenge Eustachian Tube Dysfunction

Abstract

Objective: To examine the effectiveness of Eustachian tube procedures for the treatment of baro-challenge Eustachian tube dysfunction.Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, databases, including PubMed (National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and CINAHL (EBSCO), were searched for articles examining the effectiveness of Eustachian tube procedures for baro-challenge Eustachian tube dysfunction. Outcome measures included symptom resolution, ability to return to work, equalization problems (EP) scores, Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores, and pressure chamber testing parameters. Pooled meta-analysis was performed for dichotomous measures and ETDQ-7 scores.Results: Eleven articles with 81 patients were included. Seventy-two patients from 10 articles underwent balloon Eustachian tube dilation; nine patients in 1 study underwent laser Eustachian tuboplasty (LET). All 81 patients were preoperatively symptomatic with barometric pressure change, and 26/30 (86.7%) were unable to work due to symptoms. On meta-analysis, after balloon dilation Eustachian tuboplasty (BDET), 82.5% (n = 30 [95% confidence interval: 42%-100%]) had improvement in ability to valsalva, 79.1% (n = 16 [57.9%-94.1%]) in ability to return to work, and 84.3% (n = 69 [69.8%-94.7%]) in any symptom. Of 25 patients with individual ETDQ-7 scores, 79.1% [51.4, 96.9] had improvements after BDET. For four case series with 36 patients, ETDQ-7 scores decreased by 1.2 [0.7, 1.7] (p < 0.00001). Of 20 patients with preoperative ETDQ-7 scores >2.0, there was a mean decrease of 2.1 [1.3, 2.8] (p < 0.00001).Conclusion: From the available evidence, Eustachian tube procedures appear to be effective at improving symptoms of baro-challenge Eustachian tube dysfunction. However, higher quality evidence is needed to support making definite recommendations for the use of balloon Eustachian tube dilation or LET for these patients.

Balloon Eustachian tuboplasty for obstructive Eustachian tube dysfunction: retrospective multicentre cohort study of 248 patients

“…Ungar et al [ 33 ] and Cheng et al [ 36 ] published a 100% success rate in this group of patients. A recent systematic review concludes that BET appears to be effective in improving symptoms in baro-challenge induced Eustachian dysfunction [ 37 ]. Patients with a baro-challenge ET dysfunction seem to be the best candidates for BET as their success is the highest.…”

In-office Eustachian tube balloon dilation under local anesthesia as a response to operating room restrictions associated with the COVID-19 pandemic

“…The ETDQ-7 score is limited by its subjective nature and can be affected by acute respiratory or sinunasal disease. Furthermore, some patients with normal objective findings suffer from baro-challenge-induced ETD, for which there is increased evidence on the efficacy of BDET ( 20 ). To date, no predictors of the outcome of BDET are available, and therefore, it remains unclear how many and what type of patients derived greater benefit from this intervention.…”

Permanent eustachian tube dysfunction in cabin crew member: Case report and narrative review

“…The Barochallenged Eustachian Tube Dysfunction (BCETD) is typically based on a circumstance in which sudden changes in atmospheric pressure can cause a dysfunction of Eustachian Tube [11]. The stress imposed on the mucosal surfaces of the Eustachian tube by repetitive equalization maneuvers from the increased or decreased atmospheric pressure leads to localized inflammation and mucosal edema [12].…”

“…Nowadays the best therapy is myringotomy with tube placement, but it is inconvenient for aviators and divers who rely on consistent tube patency and who could show tube otorrhea when they are on the ground [8,9]. Here follows a review of the current literature on the different kind of ET dysfunction and, in detail, we focus on BCETD in cabin crew members [11].…”