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Health Technology Assessment... Jul 2014Eustachian tube dysfunction (ETD) is the inability of the Eustachian tube (ET) to adequately perform at least one of its functions: to protect the middle ear from... (Review)
Review
BACKGROUND
Eustachian tube dysfunction (ETD) is the inability of the Eustachian tube (ET) to adequately perform at least one of its functions: to protect the middle ear from sources of disease, to ventilate the middle ear, and to help drain secretions away from the middle ear. There are a number of treatment options for ETD, but there is little consensus about management.
OBJECTIVES
To determine the clinical effectiveness of interventions for adult ETD and to identify gaps in the evidence to inform future research.
DATA SOURCES
Twelve databases were searched up to October 2012 for published and unpublished studies in English (e.g. MEDLINE from 1946, EMBASE from 1974, Biosis Previews from 1969 and Cumulative Index to Nursing and Allied Health Literature from inception). References of included studies, relevant systematic reviews and regulatory agency websites were checked.
REVIEW METHODS
A systematic review was undertaken. Controlled studies evaluating prespecified treatments for adult patients diagnosed with ETD were eligible. Uncontrolled studies with at least 10 participants were included for interventions where no controlled studies were found. Outcomes included change in symptoms severity/frequency (primary outcome), quality of life, middle ear function, hearing, clearance of middle ear effusion, early ventilation tube extrusion, additional treatment, adverse events and complications. All aspects of the review process were performed using methods to reduce reviewer error and bias. Owing to heterogeneous data, a quantitative synthesis could not be performed, and results were reported in a narrative synthesis.
RESULTS
Nineteen studies were included: three randomised controlled trials (RCTs) and two non-RCTs evaluating pharmacological interventions or mechanical devices for middle ear pressure equalisation; and 13 case series and one retrospective controlled before-and-after study evaluating surgical interventions. None was conducted in the UK. All studies were small (11 to 108 participants). Most non-surgical studies reported including mixed populations of adults and children. All except two studies were at high risk of bias, and subject to multiple limitations. Based on a single RCT, nasal steroids showed no improvement in symptoms or middle ear function for patients with otitis media with effusion and/or negative middle ear pressure. Very short-term improvements in middle ear function were observed in patients receiving directly applied topical decongestants or a combination of antihistamine and ephedrine. Single trials found two pressure equalisation devices were each associated with significant short-term improvements in symptoms, middle ear function and/or hearing. Eustachian tuboplasty (seven case series) and balloon dilatation (three case series) were associated with improved outcomes. Positive results were also reported for myringotomy (two case series), directly applied topical steroids (one case series) and laser point coagulation (one controlled before-and-after study). High rates of co-interventions were documented. Minor complications of surgery and pharmacological treatments but no serious adverse effects were reported.
LIMITATIONS
The evidence was limited in quantity and overall was of poor quality. No data were identified on several interventions despite extensive searches.
CONCLUSIONS
It is not possible to draw conclusions regarding the effectiveness of any of the interventions for the treatment of adults with an ETD diagnosis, and there is insufficient evidence to recommend a trial of any particular intervention. Further research is needed to address lack of consensus on several issues, including the definition of ETD in adults, its relation to broader middle ear ventilation problems and clear diagnostic criteria.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42012003035.
FUNDING
The National Institute for Health Research Health Technology Assessment programme.
Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Controlled Clinical Trials as Topic; Eustachian Tube; Female; Histamine Antagonists; Humans; Male; Middle Ear Ventilation; Nasal Decongestants; Otitis Media with Effusion; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Severity of Illness Index; Treatment Outcome
PubMed: 25029951
DOI: 10.3310/hta18460 -
Clinical Otolaryngology : Official... Oct 2015
Topics: Diagnosis, Differential; Ear Diseases; Eustachian Tube; Humans; Otolaryngology
PubMed: 26347263
DOI: 10.1111/coa.12475 -
Brazilian Journal of Otorhinolaryngology 2020
Topics: Acoustic Impedance Tests; Eustachian Tube
PubMed: 32209307
DOI: 10.1016/j.bjorl.2020.02.001 -
European Annals of Otorhinolaryngology,... May 2017The Eustachian (auditory) tube and tympanomastoid cavities form an anatomic and functional whole that cannot easily be divided, and is therefore known as the... (Review)
Review
The Eustachian (auditory) tube and tympanomastoid cavities form an anatomic and functional whole that cannot easily be divided, and is therefore known as the "tubotympanic system". The system has been the focus of several studies, with complex and sometimes contradictory results, making an overview of its functioning difficult to obtain. The objective of the present article is to review the current state of knowledge, as an indispensable preliminary to understanding tubotympanic system dysfunction, and notably the development of chronic otitis. The system as a whole is covered by mucosa, which provides continuity, although with certain particularities from one area to another, and plays a primordial role. Thus, under physiological conditions, gas diffusion across the tympanomastoid mucosa largely ensures the equilibrium of pressure between the middle ear and outside environment, the tube orifice being very little involved. Under large rapid change in atmospheric pressure, the aeration function of the Eustachian tube comes into play, governed by a reflex mechanism. The system also has other functions that are essential to good middle-ear functioning: protection against nasopharyngeal secretions and pathogens and against certain physiological noises; middle-ear cavity clearance by mucociliary transport of pathogens, partly related to submucosal gland secretion; and immune defense.
Topics: Chronic Disease; Ear, Middle; Eustachian Tube; Humans; Mastoid; Mucociliary Clearance; Otitis Media, Suppurative; Tympanic Membrane Perforation
PubMed: 28461039
DOI: 10.1016/j.anorl.2017.03.010 -
JMA Journal Apr 2020Patients with patulous Eustachian tubes (PET) suffer from annoying aural symptoms, such as voice or breath autophony, and aural fullness due to the ET's abnormal... (Review)
Review
Patients with patulous Eustachian tubes (PET) suffer from annoying aural symptoms, such as voice or breath autophony, and aural fullness due to the ET's abnormal patency. It may lead to an enormous reduction in quality of life. Various treatment methods, including conservative and surgical therapy, have been reported. In most cases, conservative treatment is sufficient to relieve patients of aural symptoms. However, some chronic and severe cases are resistant to traditional conservative therapy. Recently performed prospective and multicenter trials revealed the efficacy and safety of a silicone plug (Kobayashi plug) insertion for patients with severe PET. Patulous Eustachian tube handicap inventory-10 (PHI-10), tubal obstruction procedures, sitting computed tomography (CT), and ET function tests (tubo-tympano-aerodynamic graphy (TTAG) and sonotubometry) are useful for diagnosis as well as selecting candidates for surgery in severe cases.
PubMed: 33150241
DOI: 10.31662/jmaj.2020-0007 -
Cureus Nov 2022The Eustachian tube is a crucial pneumatic component of the head and neck region and is often neglected as an important site of insidious pathologies. In our literature... (Review)
Review
The Eustachian tube is a crucial pneumatic component of the head and neck region and is often neglected as an important site of insidious pathologies. In our literature review, we negotiate the management of eustachian tube dysfunction and explore the various therapeutic and surgical options available at our disposal. We begin by investigating the physiological nature of the eustachian tube and its role in the body's functioning. We also list and elaborate on the various pathologies affecting the Eustachian tube and its associated structures. The review then outlines eustachian tube dysfunction and discusses the pathophysiology involved in the genesis of the condition and its progression. Further, the review explores the tools most commonly used to diagnose or alleviate the condition, including, but not limited to, the Valsalva maneuver, Toynbee maneuver, tympanometry, pressure chamber test, and video nasopharyngoscopy. We also touch on The ETS-7 questionnaire and then on the various surgical interventions that may be used to manipulate the condition. The review also describes conventional tympanostomy and myringotomy, along with more novel techniques such as microwave ablation, laser eustachian tuboplasty, and balloon eustachian tuboplasty. We conclude by establishing the most favorable course of treatment in cases of eustachian tube dysfunction.
PubMed: 36523693
DOI: 10.7759/cureus.31432 -
Neuroradiology Jun 2016The Eustachian tube is a complex and inaccessible structure, which maintains middle ear ventilation to facilitate transmission of sound from the tympanic membrane to the... (Review)
Review
INTRODUCTION
The Eustachian tube is a complex and inaccessible structure, which maintains middle ear ventilation to facilitate transmission of sound from the tympanic membrane to the cochlea. A renewed interest in treatments for eustachian tube dysfunction has led to a demand for methods of imaging the Eustachian tube, and assessing tube opening non-invasively. This review aims to summarise the use of imaging in the anatomical assessment of the Eustachian tube, and to explore how radiological techniques can be used to assess tube function.
METHODS
A systematic review of the literature was performed with narrative data analysis.
RESULTS
With high-resolution images, the soft and bony anatomy of the Eustachian tube can be assessed in detail. CT and MRI are best suited to identifying features associated with obstructive or patulous Eustachian tube dysfunction, though true assessments of function have only been achieved with contrast enhanced radiographs and scintigraphy. A single modality has yet to provide a complete assessment. No test has entered routine clinical use, but further development and research is underway.
CONCLUSION
Significant information can be gained from imaging the Eustachian tube, and as faster acquisition techniques are developed, it is possible that dynamic imaging of tubal opening could play an important role in the assessment of patients with ET dysfunction.
Topics: Diagnosis, Differential; Ear Diseases; Eustachian Tube; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 26922743
DOI: 10.1007/s00234-016-1663-4 -
Journal of Radiology Case Reports Aug 2013Craniocervical bony pneumatization is a rare finding, with limited numbers of cases reported in the literature. It is thought to be linked to Eustachian tube dysfunction...
Craniocervical bony pneumatization is a rare finding, with limited numbers of cases reported in the literature. It is thought to be linked to Eustachian tube dysfunction and a ball valve mechanism, and has a link with recurrent Valsalva maneuvers. We report a case of pneumatization of the occiput, atlas (C1) and axis (C2) in a patient with extensive ENT (Ear, Nose and Throat) surgical history who presented following a fall. Plain film, CT and MRI images are presented.
Topics: Cervical Atlas; Emphysema; Humans; Incidental Findings; Male; Middle Aged; Occipital Bone; Rare Diseases; Spinal Diseases; Tomography, X-Ray Computed
PubMed: 24421950
DOI: 10.3941/jrcr.v7i8.1444