Interventions for adult Eustachian tube dysfunction: asystematic review

Llewellyn, Alexis; Norman, Gill; Harden, Melissa; Coatesworth, A P; Kimberling, Daniel; Schilder, Anne; McDaid, Catriona

doi:10.3310/hta18460

Cited by 122 publications

(147 citation statements)

References 58 publications

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“…There are several studies showing no effect of decongestants on ET function in patients with middle ear diseases (29,30). Besides intranasal decongestant therapy, other active pharmaceutical ingredients had been investigated by other authors for their potential to improve ET function (25).…”

Section: Discussionmentioning

confidence: 99%

Impact of Xylomethazoline on Eustachian Tube Function in Healthy Participants

Meyer¹,

Mikolajczak²,

Korthäuer³

et al. 2015

Otology &Amp; Neurotology

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Section: Discussionmentioning

confidence: 99%

Impact of Xylomethazoline on Eustachian Tube Function in Healthy Participants

Meyer¹,

Mikolajczak²,

Korthäuer³

et al. 2015

Otology &Amp; Neurotology

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“…Some mechanistic insight is gained from the correlation analysis which showed that the blood-pressure and ME responses were independent and by simple calculations documenting extremely dilute blood oxymetazoline concentrations even if the locally applied dose was completely absorbed. More reasonably, the ME effects of topical intranasal drug delivery represents a broad response of the continuous nasal-ET-ME mucosa to a localized stimulus, an effect presumed by those who recommend topical nasal decongestants to improve or prevent situational ET dysfunction 21-23 . That mechanism is also supported by empirical data for monkey experiments documenting changes in certain measures of ME mucosal blood perfusion after exposing the nasal mucosa to inflammatory substances 13,14 and is predicted by the “Unified Airway” theory 15,16 .…”

Section: Discussionmentioning

confidence: 99%

Oxymetazoline Applied Topically to the Nasal Mucosa Decreases Trans-Mucosal Nitrous Oxide Exchange for the Middle Ear

Teixeira

Alper

Martin

et al. 2015

Ann Otol Rhinol Laryngol

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Objective: Determine if the middle ear (ME) trans-mucosal nitrous oxide (N2O) gas exchange rate can be pharmacologically modulated by the nasal application of a vasoconstrictor. Methods: In a randomized, double-blind, crossover study, 20 adults received a nasal spray challenge containing either oxymetazoline or saline (placebo). At each session, subjects were fitted with a non-rebreathing mask and breathed room air for 20 minutes, 50% N2O:50% O2 for 20 minutes, and 100% O2 for 10 minutes. Throughout, heart rate, blood pressure (BP), and blood O2 saturation were monitored, and bilateral ME pressure was recorded by tympanometry every minute. The primary outcome measure was the slope of the ME pressure-time function for the experimental period, a direct measure of the transMEM N2O exchange constant. The effects of treatment, session, and period on the measured vital signs and of treatment, session, disease history, and ear on the ME pressure-time slopes were evaluated for statistical significance using repeated measures ANOVAs. Results: The analysis documented a significant effect of period on O2 saturation (N2O > room air, P = .03) and of treatment on blood pressure (oxymetazoline > placebo, P < .02) and the ME pressure-time slope (placebo > oxymetazoline, P = .05). Conclusion: The exchange rate across the ME mucosa of inert gases can be decreased by topical treatment of the nasal mucosa with oxymetazoline.

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“…The criteria used were adapted from the assessment of controlled studies and criteria used in a previous systematic review. 33 Assessment of risk of bias was undertaken independently by two researchers (except for non-English-language studies). Discrepancies were resolved by discussion.…”

Section: Assessment Of Risk Of Biasmentioning

confidence: 99%

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis

O’Connor

McCaughan

McDaid

et al. 2016

Health Technol Assess

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BackgroundPatients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee–ankle–foot orthoses (KAFOs).ObjectivesTo assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs.MethodsQualitative study of views of orthoses users – a qualitative in-depth interview study was undertaken. Data were analysed for thematic content. A coding scheme was developed and an inductive approach was used to identify themes. Systematic review – 18 databases were searched up to November 2014: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health, EMBASE, PASCAL, Scopus, Science Citation Index, BIOSIS Previews, Physiotherapy Evidence Database, Recal Legacy, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, Cochrane Central Register of Controlled Trials, Conference Proceedings Citation Index: Science, Health Management Consortium, ClinicalTrials.gov, International Clinical Trials Registry Platform and National Technical Information Service. Studies of adults using an orthosis for instability of the knee related to NMD or a CNS disorder were included. Data were extracted and quality was assessed by two researchers. Narrative synthesis was undertaken. Survey and costing analysis – a web survey of orthotists, physiotherapists and rehabilitation medicine physicians was undertaken. Telephone interviews with orthotists informed a costing analysis.ResultsQualitative study – a total of 24 people participated. Potential for engagement in daily activities was of vital importance to patients; the extent to which their device enabled this was the yardstick by which it was measured. Patients’ prime desired outcome was a reduction in pain, falls or trips, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses. Many expressed frustration with perceived deficiencies in service provision relating to appointment and administrative systems and referral pathways. Systematic review – a total of 21 studies (478 participants) were included of people who had post-polio syndrome, inclusion body myositis, were post stroke or had spinal cord injury. The studies evaluated KAFOs (mainly carbon fibre), stance control KAFO and hip KAFOs. All of the studies were at risk of bias and, in general, were poorly reported. Survey and costing analysis – in total, 238 health-care professionals responded. A range of orthoses is prescribed for knee instability that is related to NMD or CNS conditions, approximately half being custom-made. At least 50% of respondents thought that comfort and confidence in mobility were extremely important treatment outcomes. The cost of individual KAFOs was highly variable, ranging from £73 to £3553.ConclusionsVarious types of orthoses are used in the NHS to manage patients with NMD/CNS conditions and knee instability, both custom-made and prefabricated, of variable cost. Evidence on the effectiveness of the orthoses is limited, especially in relation to the outcomes that are important to orthoses users.LimitationsThe population included was broad, limiting any in-depth consideration of specific conditions. The response rate to the survey was low, and the costing analysis was based on some assumptions that may not reflect the true costs of providing KAFOs.Future workFuture work should include high-quality research on the effectiveness and cost-effectiveness of orthoses; development of a core set of outcome measures; further exploration of the views and experiences of patients; and the best models of service delivery.Study registrationThis study is registered as PROSPERO CRD42014010180. The qualitative study is registered as Current Controlled Trials ISRCTN65240228.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Interventions for adult Eustachian tube dysfunction: asystematic review

Cited by 122 publications

References 58 publications

Impact of Xylomethazoline on Eustachian Tube Function in Healthy Participants

Impact of Xylomethazoline on Eustachian Tube Function in Healthy Participants

Oxymetazoline Applied Topically to the Nasal Mucosa Decreases Trans-Mucosal Nitrous Oxide Exchange for the Middle Ear

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis

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