Clinical Consensus Statement: Balloon Dilation of the Eustachian Tube

2019 ◽  
Vol 161 (1) ◽  
pp. 6-17 ◽  
Author(s):  
Debara L. Tucci ◽  
Edward D. McCoul ◽  
Richard M. Rosenfeld ◽  
David E. Tunkel ◽  
Pete S. Batra ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Delphi Method ◽  
Consensus Statement ◽  
Expert Panel ◽  
Balloon Dilation ◽  
Target Population ◽  
Functional Health ◽  
Modified Delphi ◽  
Tube Dysfunction ◽  
Definition Of

ObjectiveTo develop a clinical consensus statement on the use of balloon dilation of the eustachian tube (BDET).MethodsAn expert panel of otolaryngologists was assembled with nominated representatives of general otolaryngology and relevant subspecialty societies. The target population was adults 18 years or older who are candidates for BDET because of obstructive eustachian tube dysfunction (OETD) in 1 or both ears for 3 months or longer that significantly affects quality of life or functional health status. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus.ResultsAfter 3 iterative Delphi method surveys, 28 statements met the predefined criteria for consensus, while 28 statements did not. The clinical statements were grouped into 3 categories for the purposes of presentation and discussion: (1) patient criteria, (2) perioperative considerations, and (3) outcomes.ConclusionThis panel reached consensus on several statements that clarify diagnosis and perioperative management of OETD. Lack of consensus on other statements likely reflects knowledge gaps regarding the role of BDET in managing OETD. Expert panel consensus may provide helpful information for the otolaryngologist considering the use of BDET for the management of patients with OETD.

scholarly journals Clinical Consensus Statement: Balloon Dilation of the Sinuses

2018 ◽  
Vol 158 (2) ◽  
pp. 203-214 ◽  
Author(s):  
Jay F. Piccirillo ◽  
Spencer C. Payne ◽  
Richard M. Rosenfeld ◽  
Fuad M. Baroody ◽  
Pete S. Batra ◽  
...  
Keyword(s):  
Ct Scan ◽  
Delphi Method ◽  
Consensus Statement ◽  
Expert Panel ◽  
Balloon Dilation ◽  
Target Population ◽  
Sinus Surgery ◽  
Consensus Statements ◽  
Strong Consensus ◽  
Definition Of

Objective To develop a clinical consensus statement on the use of sinus ostial dilation (SOD) of the paranasal sinuses. Methods An expert panel of otolaryngologists was assembled to represent general otolaryngology and relevant subspecialty societies. The target population is adults 18 years or older with chronic or recurrent rhinosinusitis (with or without nasal polyps, with or without prior sinus surgery) for whom SOD is being recommended, defined as endoscopic use of a balloon device to enlarge or open the outflow tracts of the maxillary, frontal, or sphenoid sinuses, as a standalone procedure or with endoscopic surgery. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus. Results After 3 iterative Delphi method surveys, 13 statements met the standardized definition of consensus while 45 statements did not. The clinical statements were grouped into 3 categories for presentation and discussion: (1) patient criteria, (2) perioperative considerations, and (3) outcomes. Strong consensus was obtained for not performing SOD in patients without sinonasal symptoms or positive findings on computed tomography (CT) in patients with symptoms only of headache or sleep apnea without criteria for sinusitis. In addition, strong consensus was met that CT scan of the sinuses was necessary before performing SOD and that surgeons need to understand and abide by regulations set forth by the US Food and Drug Administration if they choose to reuse/reprocess devices. Conclusion Expert panel consensus may provide helpful information for the otolaryngologist considering the use of SOD for the management of patients with a diagnosis of rhinosinusitis. This panel reached consensus on a number of statements that defined the use of SOD as inappropriate in the management of a variety of symptoms or diseases in the absence of underlying sinusitis. When patients meet the definition of chronic sinusitis as confirmed by CT scan, SOD of the sinuses can be indicated and/or effective in certain scenarios. Additional consensus statements regarding proper setting and safeguards for performing the procedure are described.

scholarly journals Clinical Consensus Statement: Ankyloglossia in Children

2020 ◽  
Vol 162 (5) ◽  
pp. 597-611 ◽  
Author(s):  
Anna H. Messner ◽  
Jonathan Walsh ◽  
Richard M. Rosenfeld ◽  
Seth R. Schwartz ◽  
Stacey L. Ishman ◽  
...  
Keyword(s):  
American Academy ◽  
Head And Neck ◽  
Delphi Method ◽  
Expert Panel ◽  
Target Population ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Older Children ◽  
Modified Delphi ◽  
Consensus Statements

Objective To identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy of Otolaryngology–Head and Neck Surgery clinical consensus statements. Methods An expert panel of pediatric otolaryngologists was assembled with nominated representatives of otolaryngology organizations. The target population was children aged 0 to 18 years, including breastfeeding infants. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus, per established methodology published by the American Academy of Otolaryngology–Head and Neck Surgery. Results After 3 iterative Delphi method surveys of 89 total statements, 41 met the predefined criteria for consensus, 17 were near consensus, and 28 did not reach consensus. The clinical statements were grouped into several categories for the purposes of presentation and discussion: ankyloglossia (general), buccal tie, ankyloglossia and sleep apnea, ankyloglossia and breastfeeding, frenotomy indications and informed consent, frenotomy procedure, ankyloglossia in older children, and maxillary labial frenulum. Conclusion This expert panel reached consensus on several statements that clarify the diagnosis, management, and treatment of ankyloglossia in children 0 to 18 years of age. Lack of consensus on other statements likely reflects knowledge gaps and lack of evidence regarding the diagnosis, management, and treatment of ankyloglossia. Expert panel consensus may provide helpful information for otolaryngologists treating patients with ankyloglossia.

scholarly journals Searching for an Operational Definition of Frailty: A Delphi Method Based Consensus Statement. The Frailty Operative Definition-Consensus Conference Project

2012 ◽  
Vol 68 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Leocadio Rodríguez-Mañas ◽  
Catherine Féart ◽  
Giovanni Mann ◽  
Jose Viña ◽  
Somnath Chatterji ◽  
...  
Keyword(s):  
Delphi Method ◽  
Consensus Statement ◽  
Operational Definition ◽  
Consensus Conference ◽  
Definition Of

Outcome of Eustachian Tube Balloon Dilation in Children: A Systematic Review

2021 ◽  
pp. 000348942110413
Author(s):  
Jeyasakthy Saniasiaya ◽  
Jeyanthi Kulasegarah ◽  
Prepageran Narayanan
Keyword(s):  
Eustachian Tube ◽  
Systematic Reviews ◽  
Balloon Dilation ◽  
Case Series ◽  
Eustachian Tube Dysfunction ◽  
Common Finding ◽  
Secondary Outcome ◽  
Large Sample Size ◽  
Line Treatment ◽  
Tube Dysfunction

Objective: Eustachian tube dysfunction (ETD) is a chronic entity that has been historically managed with adenoidectomy and ventilation tube insertion. Recently, balloon dilation of the eustachian tube has shown promising results in recalcitrant eustachian tube dysfunction. We reviewed the literature to determine the outcome of eustachian tube balloon dilation in children. Methods: A literature search was conducted for the period from 1990 to 2020 by searching several databases over a 1-month period (January 2021) according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews for Interventions. Primary outcome was defined as the success of the intervention determined by the resolution of symptoms, and secondary outcome was determined by revisions surgery and presence of complications. Results: Only 7 articles were identified based on our objectives and selection criteria. All studies included are retrospective cohort case series (Level IV) and 1 cohort of matched controls (Level III). A total of 284 patients were included in this review, with a mean age of 7.8 years. A total of 463 balloon dilation were performed either bilaterally or unilaterally. The most common finding of ETD is middle ear effusion in 5 studies. Balloon dilation of eustachian tube was second-line treatment in 6 studies and first-line treatment in 1 study. Improvement of symptoms was identified in all studies through various assessments performed. Revision surgery was performed in 1 study with no major complications reported. Conclusions: Balloon dilation of the eustachian tube may be considered as an alternative procedure following failed standard treatment in children. The quality of evidence is inadequate to recommend widespread use of the technique until a better-quality study has been completed. Future randomized controlled studies with a large sample size are warranted to determine the efficacy of this procedure amongst children.

Efficacy of balloon dilation in the treatment of symptomatic Eustachian tube dysfunction: One year follow-up study

2016 ◽  
Vol 37 (2) ◽  
pp. 99-102 ◽  
Author(s):  
Hao Xiong ◽  
Maojin Liang ◽  
Zhigang Zhang ◽  
Yaodong Xu ◽  
Yongkang Ou ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Balloon Dilation ◽  
Eustachian Tube Dysfunction ◽  
Follow Up Study ◽  
Tube Dysfunction ◽  
One Year

Eustachian Tube Balloon Dilation: A Systematic Review and Meta-analysis of Treatment Outcomes

2020 ◽  
Vol 163 (5) ◽  
pp. 870-882
Author(s):  
Michael H. Froehlich ◽  
Phong T. Le ◽  
Shaun A. Nguyen ◽  
Theodore R. McRackan ◽  
Habib G. Rizk ◽  
...  
Keyword(s):  
Systematic Review ◽  
Eustachian Tube ◽  
Valsalva Maneuver ◽  
Meta Analysis ◽  
Balloon Dilation ◽  
Eustachian Tube Dysfunction ◽  
Significant Difference ◽  
Tube Dysfunction ◽  
Outcome Metrics

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.

Balloon Eustachian tuboplasty treatment of longstanding Eustachian tube dysfunction

2017 ◽  
Vol 131 (7) ◽  
pp. 614-619 ◽  
Author(s):  
T Singh ◽  
V Taneja ◽  
K Kulendra ◽  
M Farr ◽  
J Robinson ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Eustachian Tube ◽  
Balloon Dilation ◽  
Primary Outcome Measure ◽  
Eustachian Tube Dysfunction ◽  
Secondary Outcome ◽  
Tube Dysfunction ◽  
Previously Treated ◽  
Objective Outcomes ◽  
Balloon Eustachian Tuboplasty

AbstractBackground:Eustachian tube dysfunction is a poorly defined condition associated with various symptoms and it can predispose to middle-ear disease. Balloon dilation Eustachian tuboplasty has been proposed as a treatment for Eustachian tube dysfunction.Objective:To evaluate the subjective and objective outcomes of balloon dilation Eustachian tuboplasty in patients with recurrent, previously treated chronic Eustachian tube dysfunction.Methods:The study was conducted on 11 patients (13 ears) who had undergone previous unsuccessful medical and surgical treatment. Tympanometry was the primary outcome measure. Secondary outcome measures included pure tone audiogram assessment and seven-item Eustachian Tube Dysfunction Questionnaire score.Results:Balloon dilation Eustachian tuboplasty resulted in significant improvements in 11 patients’ subjective but not objective outcome measures.Conclusion:The objective abnormality and subjective symptoms in Eustachian tube dysfunction may represent two distinct pathological processes, which may nevertheless influence and exacerbate each other.

Comparison of Balloon Dilation and Laser Eustachian Tuboplasty in Patients with Eustachian Tube Dysfunction: A Meta-analysis

2018 ◽  
Vol 158 (4) ◽  
pp. 617-626 ◽  
Author(s):  
Tang-Chuan Wang ◽  
Chia-Der Lin ◽  
Tzu-Ching Shih ◽  
Hsiung-Kwang Chung ◽  
Ching-Yuang Wang ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Balloon Dilatation ◽  
Event Rate ◽  
Valsalva Maneuver ◽  
Meta Analysis ◽  
Balloon Dilation ◽  
Outcome Data ◽  
Eustachian Tube Dysfunction ◽  
Improvement Rate ◽  
Tube Dysfunction

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.

Balloon Dilation for Obstructive Eustachian Tube Dysfunction in Children

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Joonas Toivonen ◽  
Kosuke Kawai ◽  
Joshua Gurberg ◽  
Dennis Poe
Keyword(s):  
Eustachian Tube ◽  
Balloon Dilation ◽  
Eustachian Tube Dysfunction ◽  
Tube Dysfunction

scholarly journals A Consensus Definition of Misophonia: Using a Delphi Process to Reach Expert Agreement

2021 ◽  
Author(s):  
Susan Swedo ◽  
David M. Baguley ◽  
Damiaan Denys ◽  
Laura J. Dixon ◽  
Mercede Erfanian ◽  
...  
Keyword(s):  
Delphi Method ◽  
Clinical Evidence ◽  
Consensus Building ◽  
Expert Committee ◽  
Consensus Definition ◽  
Modified Delphi ◽  
Building Process ◽  
Definition Of ◽  
Common Understanding ◽  
Iterative Voting

AbstractMisophonia is a disorder of decreased tolerance to specific sounds or their associated stimuli that has been characterized using different language and methodologies. The absence of a common understanding or foundational definition of misophonia hinders progress in research to understand the disorder and develop effective treatments for individuals suffering from misophonia. From June 2020 through January 2021, a project was conducted to determine whether a committee of experts with diverse expertise related to misophonia could develop a consensus definition of misophonia. An expert committee used a modified Delphi method to evaluate candidate definitional statements that were identified through a systematic review of the published literature. Over four rounds of iterative voting, revision, and exclusion, the committee made decisions to include, exclude, or revise these statements in the definition based on the currently available scientific and clinical evidence. A definitional statement was included in the final definition only after reaching consensus at 80% or more of the committee agreeing with its premise and phrasing. The results of this rigorous consensus-building process were compiled into a final definition of misophonia that is presented here. This definition will serve as an important step to bring cohesion to the growing field of researchers and clinicians who seek to better understand and support individuals experiencing misophonia.

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