Document Detail

Systematic review of the limited evidence base for treatments of Eustachian tube dysfunction: a health technology assessment.
MedLine Citation:
PMID:  24438176     Owner:  NLM     Status:  Publisher    
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: 1) To assess the evidence for interventions for adults with a clinical diagnosis of Eustachian tube dysfunction, 2) 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 (2 RCTs, 1 CCT, 159 patients); mechanical pressure equalisation devices (1 RCT, 1 CCT, 48 patients); and surgery, including laser tuboplasty (7 case series, 192 patients), balloon dilatation (3 case series, 103 patients), myringotomy without grommet insertion (2 case series, 121 patients), transtubal steroids (1 case series, 11 patients) and laser coagulation (1 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 high quality 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 to 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 cointervention. Therefore observed benefits for tuboplasty and balloon dilatation in symptoms, middle ear function or hearing could not be reliably attributed to the interventions assesed. 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. This article is protected by copyright. All rights reserved.
Gill Norman; Alexis Llewellyn; Melissa Harden; Andrew Coatesworth; Daniel Kimberling; Anne Schilder; Catriona McDaid
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-1-18
Journal Detail:
Title:  Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery     Volume:  -     ISSN:  1749-4486     ISO Abbreviation:  Clin Otolaryngol     Publication Date:  2014 Jan 
Date Detail:
Created Date:  2014-1-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101247023     Medline TA:  Clin Otolaryngol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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