Medical Management for Eustachian Tube Dysfunction in Adults: A Systematic Review and Meta‐Analysis

Abstract

Objective: Medical treatment for eustachian tube dysfunction (ETD) is varied, with physician preference driving treatment choice and limited guidance for these options. An evaluation of the efficacy of medical management (MM) for ETD is warranted.Methods: A systematic review of three databases (PubMed, Scopus, and Embase) was performed through December 2020. Adults treated nonsurgically for ETD were included. Exclusion criteria were as follows: patulous ETD, ETD deriving from craniofacial anomalies, or surgical treatment. Data were extracted independently by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis of continuous measures, proportions, and risk ratio was conducted.Results: Twelve articles were identified by systematic review, with either level 2 or 3 evidence. A meta-analysis of available data was performed on nine studies. A pooled cohort found 50.3% (95% confidence interval [CI], 41.7-59.0) of patients experienced symptomatic improvement with MM. ETDQ-7 scores improved in a clinically nonsignificant manner by À0.88 (95% CI, À1.12 to À0.64) following medical treatment. Further, MM benefited from subacute and chronic symptoms in 30% to 64% and 11% to 50% of cases, respectively. Intranasal corticosteroids (INCS) were not efficacious, improving only 11% to 18% of chronic cases. Therapies such as Politzer devices and Valsalva therapy had minimally beneficial results.Conclusion: Our review did not find any level 1 evidence for MM of ETD in adults. Available evidence indicates INCS are ineffective for chronic symptoms and the efficacy of nonsurgical options for subacute ETD has yet to be determined. Further randomized controlled trials are needed to discern efficacy of single-agent medical therapies.

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

“…Two other studies examining the effects of topical sympathomimetics and systemic sympathomimetics with antihistamines or placebo reported a statistically significant improvement in Eustachian tube function, but only in a small number of participants and in a short period of time, with these limitations aided by the fact that these studies did not assess symptomatic improvement ( 22 , 23 ). A recent systematic review and meta-analysis confirmed the continuing lack of evidence on the efficacy of medical management options in ETD ( 24 ). Therefore, it can be concluded that a further systematic evaluation of medical treatment of ETD in larger, prospective, and randomized-controlled trials is necessary.…”

Round Window Fistula Caused by Politzerization: An Unreported Complication

“…Efficacy in adults has been documented (12). Although some studies have not confirmed the efficacy of eustachian tube autoinflation, the current edition of Bailey's textbook (11) refers to Perera's meta-analysis (13), noting that “because of its low cost and absence of adverse effects, autoinflation might be considered for use while awaiting spontaneous resolution of the effusion” (10 (p. 1495)). Arick and Silman (14) reported on 40 children, half of whom were treated with Politzerization.…”

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

“…This becomes particularly relevant for patients who perform baro‐challenge activities for work or frequently for leisure, where barotrauma is quite common 41,42 . Strong evidence in support of medical management of ETD is lacking 43 . Although tympanostomy tubes have been a surgical option for ETD, they do not address the underlying pathology and are not without complications.…”

“…41,42 Strong evidence in support of medical management of ETD is lacking. 43 Although tympanostomy tubes have been a surgical option for ETD, they do not address the underlying pathology and are not without complications. Thus, for professional scubadivers and aviators, few treatment options exist 15 ; tympanostomy tubes are contraindicated for professional divers and military aviators and can be discouraged for commercial aviators; the frequent use of intranasal decongestants in this population remains controversial.…”