Patient Reported Outcomes of Balloon Dilation for Eustachian Tube Dysfunction Using the SNOT-22 Survey

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.

Download Full-text

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

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2015.10.010 ◽

2016 ◽

Vol 37 (2) ◽

pp. 99-102 ◽

Cited By ~ 15

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

Download Full-text

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

Otolaryngology ◽

10.1177/0194599820924322 ◽

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.

Download Full-text

Balloon Eustachian tuboplasty treatment of longstanding Eustachian tube dysfunction

The Journal of Laryngology & Otology ◽

10.1017/s0022215117000974 ◽

2017 ◽

Vol 131 (7) ◽

pp. 614-619 ◽

Cited By ~ 11

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.

Download Full-text

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

Otolaryngology ◽

10.1177/0194599817753609 ◽

2018 ◽

Vol 158 (4) ◽

pp. 617-626 ◽

Cited By ~ 7

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.

Download Full-text

Balloon Dilation for Obstructive Eustachian Tube Dysfunction in Children

Otology & Neurotology ◽

10.1097/mao.0000000000003009 ◽

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

Download Full-text

The Performance of Patient-reported Outcome Measures as Diagnostic Tools for Eustachian Tube Dysfunction

Otology & Neurotology ◽

10.1097/mao.0000000000001931 ◽

2018 ◽

Vol 39 (9) ◽

pp. 1129-1138 ◽

Cited By ~ 6

Author(s):

Matthew E. Smith ◽

Isabelle L. Cochrane ◽

Neil Donnelly ◽

Patrick R. Axon ◽

James R. Tysome

Keyword(s):

Outcome Measures ◽

Eustachian Tube ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Eustachian Tube Dysfunction ◽

Diagnostic Tools ◽

Patient Reported ◽

Tube Dysfunction

Download Full-text

New visual assessment of balloon dilation in Eustachian tube dysfunction

10.1055/s-0039-1686474 ◽

2019 ◽

Author(s):

C Quast ◽

I Todt ◽

H Sudhoff

Keyword(s):

Eustachian Tube ◽

Balloon Dilation ◽

Visual Assessment ◽

Eustachian Tube Dysfunction ◽

Tube Dysfunction

Download Full-text

Effect of Balloon Eustachian Tuboplasty in Adults That Only Have Symptoms of Chronic Eustachian Tube Dysfunction, With a 1-Year Follow-Up: Prospective Clinical Trial

Ear Nose & Throat Journal ◽

10.1177/0145561320980199 ◽

2020 ◽

pp. 014556132098019

Author(s):

Martin Formánek ◽

Debora Formánková ◽

Lukáš Školoudík ◽

Karol Zeleník ◽

Viktor Chrobok ◽

...

Keyword(s):

Clinical Trial ◽

Eustachian Tube ◽

Pure Tone Audiometry ◽

Adult Patients ◽

Eustachian Tube Dysfunction ◽

Prospective Clinical Trial ◽

Patient Reported ◽

Tube Dysfunction ◽

Balloon Eustachian Tuboplasty

Objectives: Balloon eustachian tuboplasty (BET) is a promising therapeutic option for eustachian tube (ET) dysfunction. However, data are lacking on the effect of BET in adults with symptoms of chronic ET dysfunction but without a contributing pathology. This study investigated the effect of BET in adult patients with only symptoms of chronic ET dysfunction. Methods: This prospective clinical trial included adult patients with aerated physiological middle ears and symptoms of ET dysfunction for more than 6 months. Compliance with follow-up was 93.3%. We evaluated the effects of BET with tympanometry, assessment of the Valsalva or Toynbee maneuver with tympanometry verification, a Eustachian Tube Dysfunction Questionnaire (ETDQ-7), and pure-tone audiometry. Data were recorded 1 day before surgery and 2, 6, and 12 months after BET. Therapy was considered successful when the patient exhibited a newly acquired ability to perform the Valsalva or Toynbee maneuver or when the ETDQ-7 score improved by 20% or more. Results: We included 14 ears in the analysis. After 2, 6, and 12 months, therapy was successful, according to the ETDQ-7, in 11/14 (78.6%; 95% CI: 48.8-94.3), 13/14 (92.9%; 95% CI: 64.2-99.6), and 12/14 (85.7%; 95% CI: 56.2-97.5) ears, respectively. These results were statistically significant. The ETDQ-7 scores also significantly decreased at 2, 6, and 12 months after the BET, when any change was observed. All patients experienced improvement. Only 1 patient reported temporary deterioration after 2 months. Treatment was more frequently successful in patients without nasal polyps or pollinosis. Conclusions: Adults with only symptoms of chronic ET dysfunction benefitted more and had longer lasting results from BET, compared to patients with pathologies caused by ET dysfunction. Balloon eustachian tuboplasty could be recommended for these patients.

Download Full-text

Eustachian Tube Quality of Life and Severity of Disease in Patients With Chronic Rhinosinusitis

American Journal of Rhinology and Allergy ◽

10.1177/1945892420912366 ◽

2020 ◽

Vol 34 (4) ◽

pp. 532-536 ◽

Cited By ~ 2

Author(s):

Arthur W. Wu ◽

Evan S. Walgama ◽

Thomas S. Higgins ◽

Michela Borrelli ◽

Narine Vardanyan ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Rhinosinusitis ◽

Eustachian Tube ◽

Correlation Coefficients ◽

Eustachian Tube Dysfunction ◽

Spearman Correlation ◽

Tube Dysfunction ◽

The Mean ◽

Snot 22

Background Chronic rhinosinusitis (CRS) has long been a suspected risk factor for Eustachian tube dysfunction (ETD). However, there have been few studies quantifying the presence of ETD in CRS patients. We sought to determine the prevalence of ETD symptoms in patients undergoing functional endoscopic sinus surgery (FESS) for CRS using the validated 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and to correlate the ETDQ-7 scores with scores of CRS symptom severity based on the 22-item Sino-Nasal Outcome Test (SNOT-22). Methods Patients for FESS were preoperatively administered both the ETDQ-7 and the SNOT-22 validated quality of life instruments. Pearson and Spearman correlation coefficients were calculated. Changes in ETDQ-7 were measured at 3 months and differences were compared via paired t test. Results A total of 82 patients completed the surveys. Thirty-nine (47.6%) patients had ETDQ-7 score ≥14.5, signifying clinically significant ETD symptoms. The mean ETDQ-7 score of the study population was 15.8 ± 8.8, and the mean SNOT-22 score was 37.5 ± 19.7. The Pearson and Spearman correlation coefficients between ETDQ-7 and the total SNOT-22 score were 0.52 ( P > .0001) and 0.51 ( P < .0001), respectively. There was significant improvement in ETDQ-7 scores postoperatively. Conclusion While the association between ETD and CRS has long been known, this is one of the few prospective patient studies evaluating otologic symptoms in a CRS population. We found that a significant percentage of CRS patients suffer from ETD symptoms based on patient-reported subjective outcome measures. This study demonstrates that otologic symptoms increase with CRS severity and improve after FESS.

Download Full-text