title: Interventions for adult Eustachian tube dysfunction: a systematic review.
abstract: BACKGROUND
  Eustachian tube dysfunction (ETD) is the inability of the Eustachian tube (ET) to adequately perform at least one of its functions: to protect the middle ear from sources of disease, to ventilate the middle ear, and to help drain secretions away from the middle ear. There are a number of treatment options for ETD, but there is little consensus about management.
  
  
  OBJECTIVE
  To determine the clinical effectiveness of interventions for adult ETD and to identify gaps in the evidence to inform future research.
  
  
  METHODS
  Twelve databases were searched up to October 2012 for published and unpublished studies in English (e.g. MEDLINE from 1946, EMBASE from 1974, Biosis Previews from 1969 and Cumulative Index to Nursing and Allied Health Literature from inception). References of included studies, relevant systematic reviews and regulatory agency websites were checked.
  
  
  METHODS
  A systematic review was undertaken. Controlled studies evaluating prespecified treatments for adult patients diagnosed with ETD were eligible. Uncontrolled studies with at least 10 participants were included for interventions where no controlled studies were found. Outcomes included change in symptoms severity/frequency (primary outcome), quality of life, middle ear function, hearing, clearance of middle ear effusion, early ventilation tube extrusion, additional treatment, adverse events and complications. All aspects of the review process were performed using methods to reduce reviewer error and bias. Owing to heterogeneous data, a quantitative synthesis could not be performed, and results were reported in a narrative synthesis.
  
  
  RESULTS
  Nineteen studies were included: three randomised controlled trials (RCTs) and two non-RCTs evaluating pharmacological interventions or mechanical devices for middle ear pressure equalisation; and 13 case series and one retrospective controlled before-and-after study evaluating surgical interventions. None was conducted in the UK. All studies were small (11 to 108 participants). Most non-surgical studies reported including mixed populations of adults and children. All except two studies were at high risk of bias, and subject to multiple limitations. Based on a single RCT, nasal steroids showed no improvement in symptoms or middle ear function for patients with otitis media with effusion and/or negative middle ear pressure. Very short-term improvements in middle ear function were observed in patients receiving directly applied topical decongestants or a combination of antihistamine and ephedrine. Single trials found two pressure equalisation devices were each associated with significant short-term improvements in symptoms, middle ear function and/or hearing. Eustachian tuboplasty (seven case series) and balloon dilatation (three case series) were associated with improved outcomes. Positive results were also reported for myringotomy (two case series), directly applied topical steroids (one case series) and laser point coagulation (one controlled before-and-after study). High rates of co-interventions were documented. Minor complications of surgery and pharmacological treatments but no serious adverse effects were reported.
  
  
  CONCLUSIONS
  The evidence was limited in quantity and overall was of poor quality. No data were identified on several interventions despite extensive searches.
  
  
  CONCLUSIONS
  It is not possible to draw conclusions regarding the effectiveness of any of the interventions for the treatment of adults with an ETD diagnosis, and there is insufficient evidence to recommend a trial of any particular intervention. Further research is needed to address lack of consensus on several issues, including the definition of ETD in adults, its relation to broader middle ear ventilation problems and clear diagnostic criteria.
  
  
  BACKGROUND
  This study is registered as PROSPERO CRD42012003035.
  
  
  BACKGROUND
  The National Institute for Health Research Health Technology Assessment programme.
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, UK.
authors.forename: Alexis
authors.initials: A
authors.lastname: Llewellyn
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, UK.
authors.forename: Gill
authors.initials: G
authors.lastname: Norman
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, UK.
authors.forename: Melissa
authors.initials: M
authors.lastname: Harden
authors.affiliation: Ear, Nose and Throat Department, York Hospital, York, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Coatesworth
authors.affiliation: Gale Farm Surgery, York, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kimberling
authors.affiliation: evidENT University College London Ear Institute, Royal National Throat, Nose and Ear Hospital University College London, London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Schilder
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, UK.
authors.forename: Catriona
authors.initials: C
authors.lastname: McDaid
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic; D005064:Eustachian Tube / Q000187:drug effects / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008876:Middle Ear Ventilation / Q000009:adverse effects / Q000379:methods*; D014663:Nasal Decongestants / Q000627:therapeutic use; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D006633:Histamine Antagonists; D014663:Nasal Decongestants