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Raymond MJ, Shih MC, Elvis PR, Nguyen SA, Brennan E, Meyer TA, Lambert PR. A Systematic Review of Eustachian Tube Procedures for Baro-challenge Eustachian Tube Dysfunction. Laryngoscope 2022; 132:2473-2483. [PMID: 35442523 DOI: 10.1002/lary.30132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/02/2022] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
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. Laryngoscope, 132:2473-2483, 2022.
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Affiliation(s)
- Mallory J Raymond
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Michael C Shih
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Phillip Ryan Elvis
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Emily Brennan
- Department of Research and Education Services, Medical University of South Carolina Libraries, Charleston, South Carolina, U.S.A
| | - Ted A Meyer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Paul R Lambert
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Choi SW, Oh SJ, Kim Y, Kwak MY, Suh MW, Park MK, Lee CK, Park HJ, Kong SK. A multicenter, randomized, active-controlled, clinical trial study to evaluate the efficacy and safety of navigation guided balloon Eustachian tuboplasty. Sci Rep 2021; 11:23296. [PMID: 34857843 PMCID: PMC8639820 DOI: 10.1038/s41598-021-02848-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/17/2021] [Indexed: 11/12/2022] Open
Abstract
To assess the safety and efficacy of navigation-guided balloon Eustachian tuboplasty (BET) compared to medical management (MM) alone in patients with chronic Eustachian tube dilatory dysfunction (ETD). This is a prospective, multicenter, 1:1 parallel-group, randomized controlled trial (RCT). It aims to assess the efficacy of navigation-guided BET compared to MM alone in patients with chronic ETD. The primary outcome measure was an improvement in the Eustachian tube dysfunction questionnaire (ETDQ)-7 score at the 6-week follow-up compared with baseline. Secondary outcome measures included changes in the signs and symptoms during the follow-up, changes in the score for each subcategory of ETDQ-7, type of tympanometry, pure tone audiometry, and the availability of a positive modified Valsalva maneuver. Navigation-guided BET was safely performed in all patients. A total of 38 ears of 31 patients (19 ears of 16 patients in the BET group and 19 ears of 15 patients in the control group) completed the planned treatment and 6 weeks of follow-up. More patients in the BET group (1.99 ± 0.85) had less symptomatic dysfunction than in the control group (3.40 ± 1.29) at 6 weeks post-procedure (P = 0.001). More patients experienced tympanogram improvement in the BET group at 6 weeks compared to the control group (36.5% vs. 15.8%) with a positive modified Valsalva maneuver (36.6% vs. 15.8%, P = 0.014). Additionally, air–bone gap change was significantly decreased in the BET group compared to the control group at the 6-week follow-up visit (P = 0.037). This prospective, multicenter, RCT study suggests that navigation-guided BET is a safe and superior treatment option compared to MM alone in patients with chronic ETD.
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Affiliation(s)
- Sung-Won Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Gudeok-ro 179, Seo-Gu, Busan, 49241, Republic of Korea
| | - Se-Joon Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Gudeok-ro 179, Seo-Gu, Busan, 49241, Republic of Korea
| | - Yehree Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Young Kwak
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chi Kyou Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Gudeok-ro 179, Seo-Gu, Busan, 49241, Republic of Korea.
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Laser vs microdebrider eustachian tuboplasty for the treatment of chronic adult eustachian tube dysfunction: A systematic review. World J Otorhinolaryngol Head Neck Surg 2020; 7:54-62. [PMID: 33474545 PMCID: PMC7801258 DOI: 10.1016/j.wjorl.2020.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/15/2020] [Accepted: 04/13/2020] [Indexed: 12/03/2022] Open
Abstract
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.
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Froehlich MH, Le PT, Nguyen SA, McRackan TR, Rizk HG, Meyer TA. Eustachian Tube Balloon Dilation: A Systematic Review and Meta-analysis of Treatment Outcomes. Otolaryngol Head Neck Surg 2020; 163:870-882. [PMID: 32482125 DOI: 10.1177/0194599820924322] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the effectiveness of eustachian tube balloon dilation for the treatment of eustachian tube dysfunction. DATA SOURCES PubMed, Scopus, and Google Scholar. REVIEW METHODS A systematic review of eustachian tube balloon dilation for the treatment of eustachian tube dysfunction was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify randomized control trials and prospective and retrospective studies published prior to January 31, 2019. Meta-analysis of proportions evaluated 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ7) scores, tympanometry, otoscopy findings, and the ability to perform a Valsalva maneuver. RESULTS The systematic review identified 35 studies. Twelve studies met inclusion for meta-analysis (448 patients). Mean ETDQ7 scores decreased by 2.13 from baseline to 6 weeks (95% CI, -3.02 to -1.24; P < .001). From baseline to 6 weeks, 53.0% of patients had improvement in tympanograms (P < .001). At the long-term point (3-12 months), 50.5% of patients had improved tympanograms from baseline (P < .001). There was no significant difference in the proportion of improved tympanograms at 6 weeks compared to long term (P = .535). Normal otoscopy exams at baseline increased by 30.0% at 6 weeks (P < .001) and 55.4% in the long term (P < .001). There was a 67.8% increase in proportion of patients able to perform a Valsalva maneuver in the long term compared to baseline (P < .001). CONCLUSION Eustachian tube balloon dilation appears to be associated with improvement in subjective and objective treatment outcome metrics. The improvement appears stable at 3 to 12 months after dilation. Patients with eustachian tube dysfunction are likely to benefit from balloon dilation, particularly those with medication-refractory disease.
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Affiliation(s)
- Michael H Froehlich
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Phong T Le
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Habib G Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Malik J, Ghadiali SN. Multi-scale modeling of an upper respiratory airway: Effect of mucosal adhesion on Eustachian tube function in young children. Clin Biomech (Bristol, Avon) 2019; 66:11-19. [PMID: 29395489 PMCID: PMC6067987 DOI: 10.1016/j.clinbiomech.2018.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Eustachian tube is a collapsible upper respiratory airway that is periodically opened to maintain a healthy middle ear. Young children, <10 years old, exhibit reduced Eustachian tube opening efficiency and are at risk for developing middle ear infections. Although these infections increase mucosal adhesion, it is not known how adhesion forces alters the biomechanics of Eustachian tube opening in young children. This study uses computational techniques to investigate how increased mucosal adhesion alters Eustachian tube function in young children. METHODS Multi-scale finite element models were used to simulate the muscle-assisted opening of the Eustachian tube in healthy adults and young children. Airflow during opening was quantified as a function of adhesion strength, muscle forces and tissue mechanics. FINDINGS Although Eustachian tube function was sensitive to increased mucosal adhesion in both adults and children, young children developed Eustachian tube dysfunction at significantly lower values of mucosal adhesion. Specifically, the critical adhesion value was 2 orders of magnitude lower in young children as compared to healthy adults. Although increased adhesion did not alter the sensitivity of Eustachian tube function to tensor and levator veli palatini muscles forces, increased adhesion in young children did reduced the sensitivity of Eustachian tube function to changes in cartilage and mucosal tissue stiffness. INTERPRETATIONS These results indicate that increased mucosal adhesion can significantly alter the biomechanical mechanisms of Eustachian tube function in young children and that clinical assessment of adhesion levels may be important in therapy selection.
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Affiliation(s)
- Jennifer Malik
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio 43210, United States of America
| | - Samir N Ghadiali
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio 43210, United States of America,Dorothy M. Davis Heart and Lung Research Institute, College of Medicine and Wexner Medical Center, The Ohio State University, Columbus, Ohio 43210, United States of America,Department of Internal Medicine (Division of Pulmonary, Critical Care and Sleep Medicine), Wexner Medical Center, The Ohio State University, Columbus, Ohio 43210, United States of America
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Evaluation of the Parameter "Mean Impedance" for Representing Eustachian tube Functions During Pressure Increase and Decrease in Pressure Chamber Measurements. Otol Neurotol 2019; 40:e527-e531. [PMID: 31083090 DOI: 10.1097/mao.0000000000002191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
HYPOTHESIS The hypothesis of the study is that the mean impedance (MI) during compression and decompression provides additional information of the Eustachian tube (ET) function. BACKGROUND The continuous impedance measurement in a pressure chamber can provide valuable information about the opening function of the ET. METHODS Around 55 ear-healthy volunteers were examined in a pressure chamber. These were subjected to a decompression phase and a compression phase. The pressure change was constantly 20 kPa/min. Using evaluation software, the MI could be determined for both ears in each case for the phases of compression and decompression. RESULTS In 49 participants, we could interpret the data successfully. On average, an output value (without pressure changes) of the impedance of 0.58 ±0.11 Pa on the right side and 0.43 ± 0.1 Pa on the left side were measured. During decompression, 0.098 ± 0.05 Pa (right) and 0.087 ± 0.043 Pa (left) could be determined. For compression, values of 0.086 ± 0.044 Pa on the right and 0.079 ± 0.045 Pa on the left were detected. The retest reliability was higher with an intraclass correlation coefficient for the decompression MI of 0.833 than the 0.772 compression MI. CONCLUSIONS It is possible to measure MI in healthy subjects during compression and decompression. This value represents a good average in terms of the pressure tolerance of the middle ear. In future, studies will be required to determine whether MI will be a useful parameter in differentiating normal and abnormal ET function.
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Wang TC, Lin CD, Shih TC, Chung HK, Wang CY, Tsou YA, Huang CH, Tsai MH. Comparison of Balloon Dilation and Laser Eustachian Tuboplasty in Patients with Eustachian Tube Dysfunction: A Meta-analysis. Otolaryngol Head Neck Surg 2018; 158:617-626. [PMID: 29557245 DOI: 10.1177/0194599817753609] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective We aimed to perform a meta-analysis examining balloon dilatation and laser tuboplasty for the treatment of eustachian tube dysfunction (ETD). Data Sources PubMed, Cochrane, and Embase search up to April 18, 2016, with the following keywords: eustachian, middle-ear, eustachian tuboplasty, balloon tuboplasty, laser tuboplasty, laser dilatation, and balloon dilatation. Review Methods Randomized controlled trials and prospective, retrospective, and 1-arm studies of patients with ETD treated with balloon dilatation or laser tuboplasty were included. Outcome measures were improvement of eustachian tube score (ETS) and tympanometry and Valsalva maneuver results. Results Two retrospective and 11 prospective studies were included (1063 patients; 942 treated with balloon and 121 with laser tuboplasty). Balloon tuboplasty resulted in a significant improvement of ETS (pooled standardized mean difference [SMD], 0.94; 95% confidence interval [CI], 0.23-1.66; P = .009) and, compared with laser tuboplasty, a greater tympanometry improvement rate (pooled event rate = 73% vs 13%; P = .001). Valsalva maneuver improvement rate was not different between the group results (pooled event rate = 67% vs 50%; P = .472). The maximum number of studies that provided outcome data for any one measure was only 4, and sensitivity analysis indicated ETS results may have been overly influenced by 2 studies. No balloon tuboplasty studies reported ETS data, preventing comparison between the 2 procedures. Conclusion Both procedures can improve symptoms of ETD; however, because of the limited numbers of studies reporting data of the outcomes of interest, it remains unclear if one procedure provides greater benefits.
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Affiliation(s)
- Tang-Chuan Wang
- 1 Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,2 College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Der Lin
- 1 Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,2 College of Medicine, China Medical University, Taichung, Taiwan
| | - Tzu-Ching Shih
- 3 Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Hsiung-Kwang Chung
- 1 Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,2 College of Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Yuang Wang
- 1 Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,2 College of Medicine, China Medical University, Taichung, Taiwan
| | - Yung-An Tsou
- 1 Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,2 College of Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Hsuan Huang
- 4 Department of Acupuncture, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Hsui Tsai
- 1 Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,2 College of Medicine, China Medical University, Taichung, Taiwan
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Poe D, Anand V, Dean M, Roberts WH, Stolovitzky JP, Hoffmann K, Nachlas NE, Light JP, Widick MH, Sugrue JP, Elliott CL, Rosenberg SI, Guillory P, Brown N, Syms CA, Hilton CW, McElveen JT, Singh A, Weiss RL, Arriaga MA, Leopold JP. Balloon dilation of the eustachian tube for dilatory dysfunction: A randomized controlled trial. Laryngoscope 2017; 128:1200-1206. [PMID: 28940574 DOI: 10.1002/lary.26827] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/21/2017] [Accepted: 07/05/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess balloon dilation of the Eustachian tube with Eustachian tube balloon catheter in conjunction with medical management as treatment for Eustachian tube dilatory dysfunction. STUDY DESIGN In this prospective, multicenter, randomized, controlled trial, we assigned, in a 2:1 ratio, patients age 22 years and older with Eustachian tube dilatory dysfunction refractory to medical therapy to undergo balloon dilation of the Eustachian tube with balloon catheter in conjunction with medical management or medical management alone. METHODS The primary endpoint was normalization of tympanogram at 6 weeks. Additional endpoints were normalization of Eustachian Tube Dysfunction Questionaire-7 symptom scores, positive Valsalva maneuver, mucosal inflammation, and safety. RESULTS Primary efficacy results demonstrated superiority of balloon dilation of the Eustachian tube with balloon catheter + medical management compared to medical management alone. Tympanogram normalization at 6-week follow-up was observed in 51.8% (72/139) of investigational patients versus 13.9% (10/72) of controls (P < .0001). Tympanogram normalization in the treatment group was 62.2% after 24 weeks. Normalization of Eustachian Tube Dysfunction Questionaire-7 Symptom scores at 6-week follow-up was observed in 56.2% (77/137) of investigational patients versus 8.5% (6/71) controls (P < .001). The investigational group also demonstrated substantial improvement in both mucosal inflammation and Valsalva maneuver at 6-week follow-up compared to controls. No device- or procedure-related serious adverse events were reported for those who underwent balloon dilation of the Eustachian tube. CONCLUSIONS This study demonstrated superiority of balloon dilation of the Eustachian tube with balloon catheter + medical management compared to medical management alone to treat Eustachian tube dilatory dysfunction in adults. LEVEL OF EVIDENCE 1b. Laryngoscope, 128:1200-1206, 2018.
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Affiliation(s)
- Dennis Poe
- Boston Children's Hospital, Boston, Massachusetts
| | - Vijay Anand
- Weill Cornell Medical College, Department of Otolaryngology and Head and Neck Surgery, New York, New York
| | | | - William H Roberts
- Charlotte Eye, Ear, Nose and Throat Associates, Charlotte, North Carolina
| | | | - Karen Hoffmann
- Piedmont Ear, Nose and Throat and Related Allergy, Atlanta, Georgia
| | | | - Joshua P Light
- ENT Associates of South Florida, P.A., Boynton Beach, Florida
| | - Mark H Widick
- ENT Associates of South Florida, Boca Raton, Florida
| | - John P Sugrue
- ENT and Allergy Associates, LLP Department of Otolaryngology, Port Jefferson, New York
| | - C Layton Elliott
- Witham Health Services/Memorial Hospital ENT Department, Lebanon, Indiana
| | | | | | - Neil Brown
- Meriter/UnityPoint Heathcare, Madison, Wisconsin
| | - Charles A Syms
- University of Texas Health, San Antonio, Department of Otolaryngology, San Antonio, Texas
| | - Christopher W Hilton
- HealthPartners Medical Group, Department of Otolaryngology Head and Neck Surgery, St. Paul, Minnesota
| | - John T McElveen
- Carolina Ear and Hearing Clinic, P.C., Department of Otology/ Neurotology, Raleigh, North Carolina
| | - Ameet Singh
- George Washington University Medical Center, Division of Otolaryngology, Department of Surgery, Washington, DC
| | | | - Moises A Arriaga
- Louisiana State University, School of Medicine, Department of Otolaryngology and Neurosurgery, New Orleans, Louisiana
| | - John P Leopold
- Depuy Synthes, Johnson & Johnson Medical Devices Companies, Raynham, Massachusetts, U.S.A
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Meyer MF, Jansen S, Mordkovich O, Hüttenbrink KB, Beutner D. Reliability of Eustachian tube function measurements in a hypobaric and hyperbaric pressure chamber. Clin Otolaryngol 2017; 42:1343-1349. [PMID: 28374944 DOI: 10.1111/coa.12884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Measurement of the Eustachian tube (ET) function is a challenge. The demand for a precise and meaningful diagnostic tool increases-especially because more and more operative therapies are being offered without objective evidence. The measurement of the ET function by continuous impedance recording in a pressure chamber is an established method, although the reliability of the measurements is still unclear. METHODS Twenty-five participants (50 ears) were exposed to phases of compression and decompression in a hypo- and hyperbaric pressure chamber. The ET function reflecting parameters-ET opening pressure (ETOP), ET opening duration (ETOD) and ET opening frequency (ETOF)-were determined under exactly the same preconditions three times in a row. The intraclass correlation coefficient (ICC) and Bland and Altman plot were used to assess test-retest reliability. RESULTS ICCs revealed a high correlation for ETOP and ETOF in phases of decompression (passive equalisation) as well as ETOD and ETOP in phases of compression (active induced equalisation). Very high correlation could be shown for ETOD in decompression and ETOF in compression phases. The Bland and Altman graphs could show that measurements provide results within a 95 % confidence interval in compression and decompression phases. CONCLUSIONS We conclude that measurements in a pressure chamber are a very valuable tool in terms of estimating the ET opening and closing function. Measurements show some variance comparing participants, but provide reliable results within a 95 % confidence interval in retest. This study is the basis for enabling efficacy measurements of ET treatment modalities.
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Affiliation(s)
- M F Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - S Jansen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - O Mordkovich
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - K-B Hüttenbrink
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - D Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
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10
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Miller BJ, Jaafar M, Elhassan HA. Laser Eustachian Tuboplasty for Eustachian Tube Dysfunction: a case series review. Eur Arch Otorhinolaryngol 2017; 274:2381-2387. [PMID: 28229292 DOI: 10.1007/s00405-017-4476-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/24/2017] [Indexed: 11/28/2022]
Abstract
The authors reviewed the literature regarding the safety and efficacy of Laser Eustachian Tuboplasty (LETP) in the treatment of Eustachian tube dysfunction (ETD). Medline via Pubmed, OvidSP and Science Direct were consulted, with a supplementary manual review of citations. English language case series constituted a baseline for inclusion. Primary outcome measures were pre- and post-operative tympanometry, otoscopy findings, subjective symptoms and pure tone audiometry, and findings were stratified into short term (≤6 months) and long term (>6 months-5 years). Eight unique case series were identified, detailing LETP procedures in 306 patients (462 Eustachian tubes). LETP demonstrated mixed short-term and positive long-term results across primary outcome measures. There was an overall complication rate of ≈4.4%, and no major adverse events were reported. Poor documentation of pre- and post-operative primary outcome measures and inter-study outcome heterogeneity prevents substantive comment on efficacy. Whilst LETP is safe, its use should remain limited to research in adults. Future trials should be case controlled, and detail pre- and post-operative tympanometry, otoscopy findings, subjective symptoms, and pure tone audiometry. Patients should also be stratified into those suffering from baro-challenge induced ETD, and those suffering from ETD with intractable sequelae, such as Chronic Otitis Media.
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Affiliation(s)
| | - Mustafa Jaafar
- Department of Otolaryngology, Morriston Hospital, Swansea, UK
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[The pressure-equalizing function of the Eustachian tube : Evaluation in a hypo-/hyperbaric pressure chamber]. HNO 2016; 65:634-642. [PMID: 27921116 DOI: 10.1007/s00106-016-0293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Eustachian tube connects the tympanic cavity (cavum tympani) and the nasopharynx, and enables pressure equalization between the middle ear and ambient pressure. Functional pressure compensation is very important for flying and diving in particular, due to non-physiologically large pressure differences. OBJECTIVE Evaluation of the pressure-equalizing function of the Eustachian tube is still a clinical challenge. This review article evaluates the existing data. METHODS Based on a selective literature search, different methods for evaluation of tube function are presented and evaluated, with special reference to evaluation of the pressure-equalizing function in a hypo-/hyperbaric pressure chamber. RESULTS The pressure chamber enables the dynamics of active and passive pressure compensation to be provoked and also permits accurate measurement of pressures in the millibar range. CONCLUSION A pressure chamber seems to be suitable to evaluate Eustachian tube function and therapeutic approaches to tube dysfunction. Further studies are needed to assess the value of the pressure chamber in combination with other functional tests.
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Characterizing the active opening of the eustachian tube in a hypobaric/hyperbaric pressure chamber. Otol Neurotol 2015; 36:70-5. [PMID: 25226372 DOI: 10.1097/mao.0000000000000575] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Active and passive opening of the Eustachian tube (ET) enables direct aeration of the middle ear and a pressure balance between middle ear and the ambient pressure. The aim of this study was to characterize standard values for the opening pressure (ETOP), the opening frequency (ETOF), and the opening duration (ETOD) for active tubal openings (Valsalva maneuver, swallowing) in healthy participants. DESIGN/PARTICIPANTS In a hypobaric/hyperbaric pressure chamber, 30 healthy participants (19 women, 11 men; mean age, 25.57 ± 3.33 years) were exposed to a standardized profile of compression and decompression. The pressure values were recorded via continuous impedance measurement during the Valsalva maneuver and swallowing. Based on the data, standard curves were identified and the ETOP, ETOD, and ETOF were determined. RESULTS Recurring patterns of the pressure curve during active tube opening for the Valsalva maneuver and for active swallowing were characterized. The mean value for the Valsalva maneuver for ETOP was 41.21 ± 17.38 mbar; for the ETOD, it was 2.65 ± 1.87 seconds. In the active pressure compensation by swallowing, the mean value for the ETOP was 29.91 ± 13.07 mbar; and for the ETOD, it was 0.82 ± 0.53 seconds. CONCLUSION Standard values for the opening pressure of the tube and the tube opening duration for active tubal openings (Valsalva maneuver, swallowing) were described, and typical curve gradients for healthy subjects could be shown. This is another step toward analyzing the function of the tube in compression and decompression.
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Norman G, Llewellyn A, Harden M, Coatesworth A, Kimberling D, Schilder A, McDaid C. Systematic review of the limited evidence base for treatments of Eustachian tube dysfunction: a health technology assessment. Clin Otolaryngol 2014; 39:6-21. [PMID: 24438176 DOI: 10.1111/coa.12220] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Health Technology Assessment programme commissioned a wide-ranging review of treatments for adult Eustachian tube dysfunction. Treatments range from advice and observation and pharmacological treatments to surgical options. OBJECTIVE (i) To assess the evidence for interventions for adults with a clinical diagnosis of Eustachian tube dysfunction and (ii) to identify priorities for future research. TYPE OF REVIEW Systematic review (PROSPERO registration CRD42012003035) adhering to PRISMA guidance. SEARCH An extensive search of 15 databases including MEDLINE, EMBASE and CENTRAL (up to October 2012). EVALUATION METHOD Controlled and uncontrolled studies of interventions for adult Eustachian tube dysfunction were included. Because of insufficient data, the protocol was amended to also include controlled studies with mixed adult/child populations. Risk of bias was assessed. Narrative synthesis was employed due to high clinical heterogeneity. RESULTS Interventions assessed were pharmacological treatments [two randomised controlled trials (RCTs), one controlled non-randomised trial (CCT), 159 patients]; mechanical pressure equalisation devices (one randomised controlled trial, one CCT, 48 patients); and surgery, including laser tuboplasty (seven case series, 192 patients), balloon dilatation (three case series, 103 patients), myringotomy without grommet insertion (two case series, 121 patients), transtubal steroids (one case series, 11 patients) and laser coagulation (one retrospective controlled study, 40 patients). All studies had high risk of bias except two pharmacological trials; one had low risk and one unclear risk. No evidence was found for many treatments. The single low risk of bias RCT (n = 91; 67% adults) showed no effect of nasal steroids and favoured placebo for improved middle ear function (RR 1.20, 95% CI 0.91-1.58) and symptoms (P = 0.07). Other studies showed improvements in middle ear function for mechanical devices, antihistamine/ephedrine and nasal decongestant, but they had significant methodological weaknesses including insufficient length of follow-up. None of the surgical studies were adequately controlled, and many reported high levels of co-intervention. Therefore, observed benefits for tuboplasty and balloon dilatation in symptoms, middle ear function or hearing could not be reliably attributed to the interventions assessed. There was variability in definitions of the condition. CONCLUSION Eustachian tube dysfunction is a poorly defined condition. Due to the limited and poor-quality evidence, it is inappropriate to make conclusions on the effectiveness of any intervention; the evidence base is insufficient to guide recommendations for a trial of any particular intervention. Consensus on diagnostic criteria for Eustachian tube dysfunction is required to inform inclusion criteria of future trials.
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Affiliation(s)
- G Norman
- Centre for Reviews and Dissemination, University of York, York, UK
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