[The patulous eustachian tube-novel surgical approaches]

Laser vs microdebrider eustachian tuboplasty for the treatment of chronic adult eustachian tube dysfunction: A systematic review

OBJECTIVES

Multiple treatments are described in the literature for the treatment of chronic Eustachian tube dysfunction but high-level quality evidence seems missing to support these treatments. This systematic review aimed to determine and compare the safety and efficacy of Laser Eustachian tuboplasty and Microdebrider Eustachian tuboplasty as a treatment for long-term Eustachian tube dysfunction.

DATA SOURCES

A total of 12 electronic databases were searched up to April 2018 for published and unpublished literature in the English language. References of included studies were checked.

METHODS

A systematic review was undertaken. Outcomes assessed were: primary outcomes-subjective improvement in symptoms (ETDQ-7), audiometric improvement of hearing, improvement of negative middle ear pressure noticed in tympanometry, objective improvement of tympanic membrane retraction. Secondary outcomes were-the ability to auto-insufflate Eustachian tube i.e. Valsalva manoeuvre, improved quality of life, passive tubal opening, tubomanometry, swallowing test, reduction in mucosal inflammation of Eustachian tube orifice in the nose, complications from the procedure, the need for further procedures. Results are reported in a narrative synthesis as a meta-analysis was not possible due to heterogeneous data.

RESULTS

Three studies were included. All included studies were small-scale case series (13-38 participants). Studies were conducted outside the UK. Subjective and objective improvement of Eustachian tube function was reported in all studies. But all included studies were at high risk of bias and subject to multiple limitations. No major complications were reported in either study.

CONCLUSIONS

Based on current evidence, it is not possible to recommend the clinical use of either of these two interventions i.e. Laser or Microdebrider Eustachian tuboplasty. Lack of controlled studies was identified as a gap in the evidence. Future research should be directed toward designing randomised controlled trials. These trials should use strict standard methodology and reporting criteria. Future trials should make use of consensus statement document about Eustachian tube dysfunction definition, diagnostic methods, and outcome assessment criteria to design clinical trials.

[Diagnosis and treatment of Eustachian tube dysfunction]

The Eustachian tube protects against secretion, germs and sound pressure from the nasopharynx, it acts as a drain, and serves pressure equalization in both directions so that the ear drum and sound-conducting apparatus can vibrate optimally. The incidence of Eustachian tube dysfunction in adults is about 1%, in children almost 40%. Symptoms are often unspecific. For diagnosis, the Eustachian tube score (ETS-5) can be used in patients with a perforated ear drum, and the ETS-7 score in patients with intact ear drum. Adenoid hypertrophy is a frequent cause of obstructive tube dysfunction in children. Treatment of obstructive dysfunction includes steroid nasal sprays and regular performance of the Valsalva maneuver, as well as tube dilation with the Bielefelder balloon catheter. The patulous Eustachian tube is treated with saline nasal irrigation, estrogen-nasal ointment, and craniocervical manual therapy; causal treatments are evaluated.