Laser vs microdebrider eustachian tuboplasty for the treatment of chronic adult eustachian tube dysfunction: A systematic review

Abstract

Objectives Multiple treatments are described in the literature for the treatment of chronic Eustachian tube dysfunction but high-level quality evidence seems missing to support these treatments. This systematic review aimed to determine and compare the safety and efficacy of Laser Eustachian tuboplasty and Microdebrider Eustachian tuboplasty as a treatment for long-term Eustachian tube dysfunction. Data sources A total of 12 electronic databases were searched up to April 2018 for published and unpublished literature in the English language. References of included studies were checked. Methods A systematic review was undertaken. Outcomes assessed were: primary outcomes-subjective improvement in symptoms (ETDQ-7), audiometric improvement of hearing, improvement of negative middle ear pressure noticed in tympanometry, objective improvement of tympanic membrane retraction. Secondary outcomes were-the ability to auto-insufflate Eustachian tube i.e. Valsalva manoeuvre, improved quality of life, passive tubal opening, tubomanometry, swallowing test, reduction in mucosal inflammation of Eustachian tube orifice in the nose, complications from the procedure, the need for further procedures. Results are reported in a narrative synthesis as a meta-analysis was not possible due to heterogeneous data. Results Three studies were included. All included studies were small-scale case series (13–38 participants). Studies were conducted outside the UK. Subjective and objective improvement of Eustachian tube function was reported in all studies. But all included studies were at high risk of bias and subject to multiple limitations. No major complications were reported in either study. Conclusions Based on current evidence, it is not possible to recommend the clinical use of either of these two interventions i.e. Laser or Microdebrider Eustachian tuboplasty. Lack of controlled studies was identified as a gap in the evidence. Future research should be directed toward designing randomised controlled trials. These trials should use strict standard methodology and reporting criteria. Future trials should make use of consensus statement document about Eustachian tube dysfunction definition, diagnostic methods, and outcome assessment criteria to design clinical trials.

Application of B-ultrasound for localization and its impact on first-attempt success rates of nasogastric tube insertion in critically ill patients

“…Given the critical condition of ICU patients and their pain and intolerance towards nasointestinal tube implantation, propofol was used for sedation, sufentanil for auxiliary analgesia, and metoclopramide administered orally to prevent nausea and vomiting caused by tube implantation. [ 31 , 32 ][33] The results suggested that B-ultrasound-assisted nasointestinal tube insertion was superior to blind insertion regarding the time to reach the target nutritional value. Furthermore, B-ultrasound-guided intragastric water injection for nasointestinal tube placement could potentially shorten the time to reach target nutritional value.…”

Rare case of ballooning herniation of the tympanic membrane

“…Eustachian tube dysfunction is defined by signs and symptoms of pressure dysregulation in the middle ear such as ‘aural fullness’, ‘popping’, discomfort, pain or ‘under water sensation’ 11 and represents a common problem with reported incidences ranging from 0.9% to 5%. 19 …”

“…26 Present evidence to support its alternatives, such as laser Eustachian tuboplasty and microdebrider Eustachian tuboplasty, is limited in quantity and of poor quality. 19 Although Sadé described cases of a ballooning tympanic membrane returning to its physiological level after being punctured, 17 we do not recommend this approach.…”

“…Eustachian tube dysfunction is defined by signs and symptoms of pressure dysregulation in the middle ear such as 'aural fullness', 'popping', discomfort, pain or 'under water sensation' 11 and represents a common problem with reported incidences ranging from 0.9% to 5%. 19 According to Schilder et al, the three subtypes of Eustachian tube dysfunction include barochallenge-induced dysfunction in conditions of alteration of the ambient pressure, patulous Eustachian tube dysfunction and dilatory Eustachian tube dysfunction. The latter can be broken down into functional obstruction, dynamic dysfunction due to muscular failure and anatomical obstruction.…”

“…Present evidence to support its alternatives, such as laser Eustachian tuboplasty and microdebrider Eustachian tuboplasty, is limited in quantity and of poor quality. 19 …”