Treatment Effectiveness for Symptoms of Patulous Eustachian Tube

Luu, Kimberly; Remillard, Andrew; Fandiño, Marcela; Saxby, Alexander J.; Westerberg, Brian D.

doi:10.1097/mao.0000000000000900

Cited by 26 publications

(32 citation statements)

References 43 publications

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“…Half of patients experienced resolution of their PETD symptoms lasting over 1 year, similar to rates of symptom resolution reported in two recent meta‐analysis . There were differences, however, among the procedures in the duration of symptom resolution.…”

Section: Discussionsupporting

confidence: 80%

“…Half of patients experienced resolution of their PETD symptoms lasting over 1 year, similar to rates of symptom resolution reported in two recent meta-analysis. 25,26 There were differences, however, among the procedures in the duration of symptom resolution. Placement of a shim had lower rates of failure at 12 months compared to injection of calcium hydroxyapatite cement and to procedures intending to reconstruct the ET lumen.…”

Section: Discussionmentioning

confidence: 97%

“…20 Two recent systematic reviews showed a wide range of outcomes with heterogeneous study design, limiting the ability to compare groups. 25,26 There is little data on long-term outcomes of the above nasopharyngeal procedures, and there have been no studies at a single institution comparing outcomes among them. This study aims to examine the 12-month effectiveness of these procedures.…”

Section: Introductionmentioning

confidence: 99%

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Twelve‐month outcomes of Eustachian tube procedures for management of patulous Eustachian tube dysfunction

et al. 2018

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Objective To determine the 12‐month effectiveness of transnasal–transoral endoscopic surgical procedures for eliminating symptoms of patulous Eustachian tube dysfunction (PETD). Study Design Retrospective chart review Methods Patients with medically refractory PETD underwent one of the following procedures: 1) shim (catheter) insertion, 2) calcium hydroxyapatite injection, 3) patulous Eustachian tube (ET) reconstruction, or 4) obliteration of the ET lumen. Time to recurrence of any PETD symptoms was recorded, and success was determined as complete symptom resolution at 12 months. The frailty model, an extension of the Cox proportional hazards model, was used for the survival analysis. Results A total of 241 procedures were performed in 80 patients. Median duration of symptom relief after surgery was 5.0 months (interquartile range [IQR]: 1.1–15.5 months) and varied by procedure type, ranging from 3.0 months (IQR: 0.7–7.0 months) for calcium hydroxyapatite injection to 20.6 months (3.4–35.9 months) for obliteration. Compared to shim insertion, the risk of 12‐month failure was significantly higher for calcium hydroxyapatite injection (hazard ratio [HR] = 2.18; 95% confidence interval [CI] 1.29, 3.67; P = 0.004) and patulous ET reconstruction (HR = 1.62; 95% CI 1.04, 2.52; P = 0.035). Patients undergoing shim insertion (52.2%) and obliteration (81.8%) were likely to require pressure equalization tubes or to have had otitis media with effusion. Conclusion Although all procedures potentially resulted in symptom resolution, placement of a shim or obliteration of the ET lumen was more likely to achieve 12‐month resolution of PETD symptoms and more likely to result in otitis media with effusion than hydroxyapatite injection or patulous ET reconstruction. Level of Evidence Level 4 Laryngoscope, 129:222–228, 2019

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Twelve‐month outcomes of Eustachian tube procedures for management of patulous Eustachian tube dysfunction

et al. 2018

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“…To our knowledge, this is the first prospective and multicenter case series of surgical treatment for PET. Two systematic reviews regarding surgical procedures for PET had been reported in 2015 . Several surgical methods have been reported, including manipulation of TM, injection into the submucosa of the ET, shim surgery, plug surgery, ET reconstruction, and permanent closure of the ET.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a silicone plug for patulous eustachian tube: A prospective, multicenter case series

et al. 2019

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Objectives/Hypothesis: To report the efficacy and safety of transtympanic plugging of the eustachian tube (ET) using a silicone plug (Kobayashi plug) for chronic patulous ET (PET).Study Design: Prospective and multicenter trial conducted in which 30 PET patients were resistant to at least 6 months of conservative treatment.Methods: The efficacy and safety of 28 and 27 patients, respectively, were analyzed. All patients fulfilled inclusion and exclusion criteria. The primary end point used the patulous eustachian tube handicap inventory-10 (PHI-10), and the secondary end point used ET function tests such as sonotubometry, tubo-tympano-aerodynamic-graphy, and respiratory movement of the tympanic membrane and auscultation of voice sounds transmitted from the nose through the ET to the external auditory canal at 3months after surgery.Results: PHI-10 scores were 34.4 AE 4.2, 6.4 AE 9, and 5.7 AE 8.6 at screening, and 3 and 6 months after surgery. Twentythree cases (82.1%, 95% confidence interval: 63.1%-93.9%) were judged as successes. There were five cases (17.2%) of middle ear effusion, four cases (13.8%) of tympanic membrane perforation, and one case of tinnitus due to surgery to remove the plug. No severe or life-threatening complications were found.Conclusions: This study revealed the efficacy and safety of silicone plug insertion for severe PET patients.

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“…computed tomography or tympanometry) have been used to improve the diagnosis of patulous Eustachian tube, it remains a clinical diagnosis based on mentioned symptoms and visualisation of tympanic membrane movement with respiration. 4 There is currently no general consensus regarding patulous Eustachian tube management. A variety of non-surgical treatments (e.g.…”

Section: Introductionmentioning

confidence: 99%

Saline injection to determine the volume required for personalised patulous Eustachian tube augmentation with long-standing material

et al. 2018

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ObjectiveThere is currently no general consensus on patulous Eustachian tube management. Injection of autologous fat, cartilage or hydroxylapatite has been described for Eustachian tube occlusion, with promising results. However, complete resolution of symptoms is not achieved in all cases. This could be connected to the amount of material injected into the surroundings of the Eustachian tube, as this greatly differs among existing studies. Identifying the appropriate volume of injected material could be challenging because anatomical conditions vary among patients, and there is always a risk of chronic Eustachian tube obstruction and its related complications when too much long-standing material is injected.Case reportA case is presented wherein saline was injected under local anaesthesia to determine the volume required and to predict the success of patulous Eustachian tube augmentation with long-standing material.ConclusionThis approach could allow more personalised treatment and help identify patients likely to benefit from the procedure.

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Treatment Effectiveness for Symptoms of Patulous Eustachian Tube

Abstract: The available evidence for management of patients with PET is poor in quality and consists predominantly of small case series. Further research is needed to determine the comparative efficacy of the current treatments.

Cited by 26 publications

References 43 publications

Twelve‐month outcomes of Eustachian tube procedures for management of patulous Eustachian tube dysfunction

Twelve‐month outcomes of Eustachian tube procedures for management of patulous Eustachian tube dysfunction

Efficacy of a silicone plug for patulous eustachian tube: A prospective, multicenter case series

Saline injection to determine the volume required for personalised patulous Eustachian tube augmentation with long-standing material

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