Surgical management of Patulous eustachian tube: A systematic review

Abstract

Objectives Patulous Eustachian tube (PET) is a challenging clinical problem with limited medical and surgical options. The current study systematically reviews the literature to determine the safety and efficacy of surgical treatments for PET. Data Sources Medline, Google Scholar, and Cochrane databases. Methods Studies evaluating the surgical management of PET were extracted based on defined inclusion criteria. Data including surgical techniques, outcomes, and complications were extracted and analyzed. Results 1616 studies were retrieved from the initial search. Fourteen studies comprising a total of 226 patients (253 sides) met inclusion criteria and were evaluated for surgical techniques, patient outcomes and complications. All studies were classified as Level 4 evidence per definition provided by the Oxford Center for Evidence Based Medicine. The most commonly reported techniques were ET plugging (3 studies), PE tube placement (2 studies), and suture ligation (2 studies). Postoperative follow-up ranged from 2 to 60 months (mean, 20.6 months). Outcome measures varied significantly between individual studies, with overall symptom improvement reported at between 22% and 100% (mean 72.4%, 95% CI 62.5% - 81.2%). A low incidence of minor complications was reported in 9 of 14 studies. Conclusions Current literature evaluating the surgical management of PET is limited and comprised entirely of Level 4 studies. Comparisons between techniques were not possible due to the small number of studies and variable outcome measures. Future larger studies evaluating defined outcomes and quality of life measures are needed to determine the comparative efficacy of surgical treatments for this challenging condition.

Twelve‐month outcomes of Eustachian tube procedures for management of patulous Eustachian tube dysfunction

“…Half of patients experienced resolution of their PETD symptoms lasting over 1 year, similar to rates of symptom resolution reported in two recent meta‐analysis . There were differences, however, among the procedures in the duration of symptom resolution.…”

Treatment Effectiveness for Symptoms of Patulous Eustachian Tube

“…During manuscript preparation, a systematic review of the surgical management of patients with PET was published (7). This review was comprehensive for surgical management without consideration of options for medical management.…”

“…Hussein et al (7) recently published a review of surgical treatment options, but did not look at medical treatments. The number of different treatment options highlights that there is no single effective treatment for symptoms of PET.…”

Endoscope‐assisted silicone plug insertion for patulous Eustachian tube patients

“…Most cases can be cured by explaining the disease of PET mechanism to the patient, providing reassurance and performing conservative therapy. However, in severe cases that are resistant to conservative treatment, surgical treatments are needed to control PET symptoms . Several surgical treatments have been reported, including a method that we previously published: the transtympanic silicone plug (Kobayashi Plug) insertion, for cases of severe PET.…”

“…However, in severe cases that are resistant to conservative treatment, surgical treatments are needed to control PET symptoms. 2 Several surgical treatments have been reported, including a method that we previously published: the transtympanic silicone plug (Kobayashi Plug) insertion, 3,4 for cases of severe PET. This method has been performed using a microscope in the outpatient clinic for 252 ears with severe PET and was effective for about 80% of the cases.…”