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Luukkainen V, Kivekäs I, Silvola J, Jero J, Sinkkonen ST. Balloon Eustachian Tuboplasty: Systematic Review of Long-term Outcomes and Proposed Indications. J Int Adv Otol 2019; 14:112-126. [PMID: 29764785 DOI: 10.5152/iao.2018.4769] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Balloon Eustachian tuboplasty (BET) aims to improve the function of the Eustachian tube (ET). The objective of this study was to review the long-term outcome of BET and present the process and results of outlining indications for BET by the Finnish Otosurgical Society. The literature review is based on a database search performed in May 2017. The search resulted in 100 individual articles, which were screened for relevance. Five articles fulfilled the inclusion criteria (follow-up ≥12 months). Five additional articles (follow-up, 6-11 months) were analyzed to obtain supportive information. The proposed BET indications were constituted in the 2016 annual meeting of the Finnish Otosurgical Society. The workshop included a review of the Eustachian tube physiology, middle ear aeration mechanisms, and BET outcome studies. Thereafter, the members of the Society first voted and then discussed 14 cases in order to conclude whether BET was indicated in each case, and subsequently, a consensus statement on the indications for BET was outlined. The long-term follow-up studies were heterogeneous regarding the Eustachian tube dysfunction (ETD) definition, patient selection, follow-up duration, additional treatments, and outcome measures. The current, but limited, evidence suggests that BET is effective in the long-term. However, more long-term studies with uniform criteria and outcome measures as well as placebo-controlled studies are needed. The proposed indications for BET by the Finnish Otosurgical Society include chronic bothersome symptoms referring to ETD, ETD-related symptoms when pressure changes rapidly, or recurring serous otitis media. With the current evidence, we suggest treating only adults with BET.
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Affiliation(s)
- Veera Luukkainen
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Juha Silvola
- Department of Otorhinolaryngology, Akershus University Hospital and Campus AHUS/University of Oslo, Akershus and Oslo, Norway
| | - Jussi Jero
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Saku T Sinkkonen
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Abstract
BACKGROUND It is a known fact that bacterial or viral acute otitis media occurs more frequently in the winter months. Only a few older studies on seasonal differences in middle ear findings are available. These studies are based solely on tympanography, without correlation to intraoperative middle ear findings. This study addresses the question of whether seasonal differences can be found in the preoperative tympanogram and in the corresponding intraoperative findings in children with chronic middle ear problems. PATIENTS AND METHODS This retrospective study included patients who had undergone myringotomy with or without tympanostomy tube insertion at the Charité-Universitätsmedizin Berlin between January and December 2011. Corresponding to the catarrhal phases, winter months were defined as those from November to April; summer months from May to October. The preoperative tympanogram and the documented intraoperative middle ear finding were statistically analyzed for seasonal differences. RESULTS A total of 654 ears from 206 male and 127 female patients with mean age 3.7 ± 2.5 years were analyzed. In the majority of cases, a type B tympanogram was found (n = 376; 57.5%), whereas the middle ear was filled with air in 19.1% of cases. No significant seasonal differences were found for either the intraoperative middle ear findings or the preoperative tympanograms (p > 0.05). CONCLUSION For children with a typical history of chronic otitis media without effusion and chronic tube ventilation dysfunction, myringotomy with or without tympanostomy tube insertion is indicated independently of the season. The results indicate that a wait-and-see approach with hope of improvement during the summer months is not rational.
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A Systematic Literature Review of the Safety and Efficacy of Eustachian Balloon Tuboplasty in Patients with Chronic Eustachian Tube Dysfunction. Indian J Otolaryngol Head Neck Surg 2019; 71:406-412. [PMID: 31559212 DOI: 10.1007/s12070-019-01637-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/26/2019] [Indexed: 11/27/2022] Open
Abstract
Eustachian tube dysfunction (ETD) is a common condition afflicting 1% of the adult population and is said to be higher in the pediatric population. Currently, it is primarily managed with medical therapy. However, newer management techniques like balloon tuboplasty have been introduced. To systematically review the available evidence on eustachian tube balloon dilation for treating chronic ETD covering indications, efficacy, safety, short term, and long term outcomes, a literature search was conducted on Google Scholar and Pubmed. 21 publications met the inclusion criteria. Based on the literature review the procedure was found to be effective in alleviating symptoms in adult and pediatric patients immediately postoperatively and long term, up to 5 years. The adverse event rate was 3% and these were mostly minor self-resolving complications. The perioperative protocol varies from center to center. Balloon tuboplasty was found to be safe and efficacious in the short and long term post operatively in select patients with chronic ETD.
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Balloon dilatation of the Eustachian tube in adult patients with chronic dilatory tube dysfunction: a retrospective cohort study. Eur Arch Otorhinolaryngol 2017; 275:395-400. [DOI: 10.1007/s00405-017-4857-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/22/2017] [Indexed: 11/26/2022]
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Huisman JML, Verdam FJ, Stegeman I, de Ru JA. Treatment of Eustachian tube dysfunction with balloon dilation: A systematic review. Laryngoscope 2017; 128:237-247. [DOI: 10.1002/lary.26800] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 06/15/2017] [Accepted: 06/21/2017] [Indexed: 11/08/2022]
Affiliation(s)
| | - Froukje Jantina Verdam
- Department of Otorhinolaryngology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Jacob Alexander de Ru
- Department of Otorhinolaryngology; University Medical Centre Utrecht; Utrecht The Netherlands
- Department of Otorhinolaryngology; Central Military Hospital Utrecht; Utrecht The Netherlands
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Alper CM, Luntz M, Takahashi H, Ghadiali SN, Swarts JD, Teixeira MS, Csákányi Z, Yehudai N, Kania R, Poe DS. Panel 2: Anatomy (Eustachian Tube, Middle Ear, and Mastoid-Anatomy, Physiology, Pathophysiology, and Pathogenesis). Otolaryngol Head Neck Surg 2017; 156:S22-S40. [PMID: 28372527 DOI: 10.1177/0194599816647959] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective In this report, we review the recent literature (ie, past 4 years) to identify advances in our understanding of the middle ear-mastoid-eustachian tube system. We use this review to determine whether the short-term goals elaborated in the last report were achieved, and we propose updated goals to guide future otitis media research. Data Sources PubMed, Web of Science, Medline. Review Methods The panel topic was subdivided, and each contributor performed a literature search within the given time frame. The keywords searched included middle ear, eustachian tube, and mastoid for their intersection with anatomy, physiology, pathophysiology, and pathology. Preliminary reports from each panel member were consolidated and discussed when the panel met on June 11, 2015. At that meeting, the progress was evaluated and new short-term goals proposed. Conclusions Progress was made on 13 of the 20 short-term goals proposed in 2011. Significant advances were made in the characterization of middle ear gas exchange pathways, modeling eustachian tube function, and preliminary testing of treatments for eustachian tube dysfunction. Implications for Practice In the future, imaging technologies should be developed to noninvasively assess middle ear/eustachian tube structure and physiology with respect to their role in otitis media pathogenesis. The new data derived from these structure/function experiments should be integrated into computational models that can then be used to develop specific hypotheses concerning otitis media pathogenesis and persistence. Finally, rigorous studies on medical or surgical treatments for eustachian tube dysfunction should be undertaken.
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Affiliation(s)
- Cuneyt M Alper
- 1 Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,3 Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michal Luntz
- 4 Department of Otolaryngology Head and Neck Surgery, Bnai Zion Medical Center; Technion-The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Haruo Takahashi
- 5 Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Samir N Ghadiali
- 6 Department of Biomedical Engineering, Ohio University, Columbus, Ohio, USA.,7 Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Ohio University, Columbus, Ohio, USA
| | - J Douglas Swarts
- 2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Miriam S Teixeira
- 2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Zsuzsanna Csákányi
- 8 Department of Pediatric Otorhinolaryngology, Heim Pal Children's Hospital, Budapest, Hungary
| | - Noam Yehudai
- 4 Department of Otolaryngology Head and Neck Surgery, Bnai Zion Medical Center; Technion-The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Romain Kania
- 9 Department of Otorhinolaryngology-Head and Neck Surgery, Lariboisière Hospital, Diderot University, University Paris Sorbonne, Paris, France
| | - Dennis S Poe
- 10 Department of Otology and Laryngology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA.,11 Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
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[Balloon dilatation of the Eustachian tube during middle ear surgery : Study planning and first experiences during recruitment]. HNO 2017; 64:237-42. [PMID: 27002857 DOI: 10.1007/s00106-016-0146-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Eustachian tube dysfunction is considered a major contributor to chronic middle ear disease. In clinical case series, the results of balloon dilation (balloon Eustachian tuboplasty, BET) as a treatment for Eustachian tube dysfunction have been reported. OBJECTIVE This study aims to analyze whether patients undergoing planned surgery for chronic middle ear disease would benefit from additional BET. METHODS In a randomized controlled, patient and observer (not surgeon)-blind clinical study, 100 adult patients with planned surgery for chronic middle ear disease will be investigated. Patients will be randomized into two groups, one of which (50%) will receive additional BET of the affected side during the planned surgery. Eustachian tube function will be evaluated using the Valsalva maneuver and tubomanometry according to Estève, as well as on the basis of patient reports. Various scores will be used as outcome measures, including ETS-5 (Eustachian Tube Score 5), the extended version ETS-7, and the ETDQ-7 (Seven-Item Eustachian Tube Dysfunction Questionnaire). Follow-up is at 3, 6, and 12 months. RESULTS From June to December 2015, 162 patients underwent microscopic ear surgery. Inclusion criteria were not fulfilled by 90 patients. Of the remaining 72 patients with chronic middle ear disease, 12 patients (17%) have been randomized so far, 28 (39%) did not exhibit Eustachian tube dysfunction, and 32 (44%) patients could not be included for other reasons. CONCLUSION The rate of recruitment was lower than expected. Depending on the case number calculations for the patient groups identified in the study for whom BET might be particularly beneficial, multicenter studies in specific disease groups may follow.
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Knopke S, Böttcher A, Chadha P, Olze H, Bast F. Seasonal differences of tympanogram and middle ear findings in children. HNO 2016; 65:68-72. [PMID: 27995276 DOI: 10.1007/s00106-016-0288-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND It is a known fact that bacterial or viral acute otitis media occurs more frequently in the winter months. Only a few older studies on seasonal differences in middle ear findings are available. These studies are based solely on tympanography, without correlation to intraoperative middle ear findings. This study addresses the question of whether seasonal differences can be found in the preoperative tympanogram and in the corresponding intraoperative findings in children with chronic middle ear problems. PATIENTS AND METHODS This retrospective study included patients who had undergone myringotomy with or without tympanostomy tube insertion at the Charité-Universitätsmedizin Berlin between January and December 2011. Corresponding to the catarrhal phases, winter months were defined as those from November to April; summer months from May to October. The preoperative tympanogram and the documented intraoperative middle ear finding were statistically analyzed for seasonal differences. RESULTS A total of 654 ears from 206 male and 127 female patients with mean age 3.7 ± 2.5 years were analyzed. In the majority of cases, a type B tympanogram was found (n = 376; 57.5%), whereas the middle ear was filled with air in 19.1% of cases. No significant seasonal differences were found for either the intraoperative middle ear findings or the preoperative tympanograms (p > 0.05). CONCLUSION For children with a typical history of chronic otitis media without effusion and chronic tube ventilation dysfunction, myringotomy with or without tympanostomy tube insertion is indicated independently of the season. The results indicate that a wait-and-see approach with hope of improvement during the summer months is not rational.
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Affiliation(s)
- S Knopke
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - A Böttcher
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Chadha
- Craniofacial Unit, Chelsea and Westminster Hospital, London, UK
| | - H Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Bast
- Department of Otorhinolaryngology, AMEOS Klinikum Haldensleben, Haldensleben, Germany
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Teschner M. Evidence and evidence gaps in the treatment of Eustachian tube dysfunction and otitis media. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 15:Doc05. [PMID: 28025605 PMCID: PMC5169078 DOI: 10.3205/cto000132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Evidence-based medicine is an approach to medical treatment intended to optimize patient-oriented decision-making on the basis of empirically proven effectiveness. For this purpose, a classification system has been established to categorize studies - and hence therapy options - in respect of associated evidence according to defined criteria. The Eustachian tube connects the nasopharynx with the middle ear cavity. Its key function is to ensure middle ear ventilation. Compromised ventilation results in inflammatory middle ear disorders. Numerous evidence-based therapy options are available for the treatment of impaired middle ear ventilation and otitis media, the main therapeutic approach being antibiotic treatment. More recent procedures such as balloon dilation of the Eustachian tube have also shown initial success but must undergo further evaluation with regard to evidence. There is, as yet, no evidence for some of the other long-established procedures. Owing to the multitude of variables, the classification of evidence levels for various treatment approaches calls for highly diversified assessment. Numerous evidence-based studies are therefore necessary in order to evaluate the evidence pertaining to existing and future therapy solutions for impaired middle ear ventilation and otitis media. If this need is addressed, a wealth of implications can be expected for therapeutic approaches in the years to come.
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Affiliation(s)
- Magnus Teschner
- Department of Otolaryngology, Head and Neck Surgery, Hannover Medical School, Hannover, Germany
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[Does balloon dilatation represent a breakthrough for Eustachian tube disorders – even in children?]. HNO 2016; 63:681-2, 684-5. [PMID: 26385899 DOI: 10.1007/s00106-015-0047-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Balloon dilatation is a promising new treatment for Eustachian tube dysfunction which is becoming more and more popular in Germany. There are a number of single publications and even meta-analyses on this topic, which demonstrate good results but also reveal the need for better studies. Initially tube dilatation was applied only in adults with tube dysfunctions but recently some centers even recommend it for children with long-lasting or frequently recurring middle ear effusion, which is resistant to conventional therapy. This article provides a critical appraisal based on the current literature and emphasizes the need for controlled studies. Due to the poor definition of tube dysfunctions it may be difficult to establish informative studies but in terms of evidence-based medicine there is need for a precise definition of indications and inclusion criteria. Most important is that such studies must include control groups, which has so far not been the case. Moreover, there should be a consensus about the criteria for defining success. Although all publications claim that balloon tuboplasty is a safe method, the question whether or not preoperative computed tomography (CT) scans are needed should be considered in each individual case. Nevertheless, balloon dilatation is a very promising method offering a new approach to the problem of Eustachian tube dysfunction.
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Schröder S, Lehmann M, Ebmeyer J, Upile T, Sudhoff H. Balloon Eustachian tuboplasty: a retrospective cohort study. Clin Otolaryngol 2015; 40:629-38. [DOI: 10.1111/coa.12429] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S. Schröder
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
| | - M. Lehmann
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
| | - J. Ebmeyer
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
| | - T. Upile
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
| | - H. Sudhoff
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
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Abstract
Objective A systematic review and meta-analysis of the evidence on balloon Eustachian tuboplasty (BET) as a treatment modality for Eustachian tube dysfunction (ETD). We followed the PRISMA guideline and registered with PROSPERO No. CRD42014009461. Data Sources We searched 12 databases including PubMed and Embase from January 1, 2010, to April 7, 2014, for studies of BET. Endpoints: change in symptoms, middle ear pathology, eardrum status, Eustachian tube function tests, hearing, adverse events, complications, and health-related quality of life. Review Methods Study quality was assessed using the modified Delphi technique quality appraisal tool for case series studies. Risk of bias was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. Results Nine case series studies with 443 patients (642 tubes) were included. Population size n = 4 (7 tubes) to n = 210 (320 tubes). All studies were of poor quality and featured a high risk of bias. We found reduction of patient symptoms in ETD questionnaire ( P < .001), postoperative normalization of the tympanic membrane, conversion of type B or type C into type A tympanograms, reduced mucosal inflammation, increased number of positive Valsalva test and Swallowing tests, improvement in Eustachian tube score, reduction in Sino-Nasal Outcome Test (SNOT)-22 score ( P = .001), and increased quality of life ( P = .001). No serious adverse events were found. Conclusion The evidence of BET is poor and biased. No firm conclusions can be made to identify patients who will benefit from the procedure or to accurately predict surgical results. Randomized controlled trials or case-control trials are needed.
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Affiliation(s)
- Thomas Skov Randrup
- Department of ENT, Head and Neck Surgery, Aarhus University Hospital, Århus C, Denmark
| | - Therese Ovesen
- Department of ENT, Head and Neck Surgery, Aarhus University Hospital, Århus C, Denmark
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The relationship between preoperative tympanograms and intraoperative ear examination results in children. Eur Arch Otorhinolaryngol 2014; 272:3651-4. [DOI: 10.1007/s00405-014-3421-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/27/2014] [Indexed: 11/25/2022]
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