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Interventions for adult Eustachian tube dysfunction: a systematic review

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Interventions for adult Eustachian tube dysfunction : a systematic review. / Llewellyn, Alexis; Norman, Gill; Harden, Melissa; Coatesworth, Andrew; Kimberling, Daniel; Schilder, Anne; McDaid, Catriona.

In: Health technology assessment, Vol. 18, No. 46, 07.2014, p. 1-180.

Research output: Contribution to journalArticle

Harvard

Llewellyn, A, Norman, G, Harden, M, Coatesworth, A, Kimberling, D, Schilder, A & McDaid, C 2014, 'Interventions for adult Eustachian tube dysfunction: a systematic review', Health technology assessment, vol. 18, no. 46, pp. 1-180.

APA

Llewellyn, A., Norman, G., Harden, M., Coatesworth, A., Kimberling, D., Schilder, A., & McDaid, C. (2014). Interventions for adult Eustachian tube dysfunction: a systematic review. Health technology assessment, 18(46), 1-180.

Vancouver

Llewellyn A, Norman G, Harden M, Coatesworth A, Kimberling D, Schilder A et al. Interventions for adult Eustachian tube dysfunction: a systematic review. Health technology assessment. 2014 Jul;18(46):1-180.

Author

Llewellyn, Alexis ; Norman, Gill ; Harden, Melissa ; Coatesworth, Andrew ; Kimberling, Daniel ; Schilder, Anne ; McDaid, Catriona. / Interventions for adult Eustachian tube dysfunction : a systematic review. In: Health technology assessment. 2014 ; Vol. 18, No. 46. pp. 1-180.

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@article{7ef1e4013e3742e2968da960ced92fbf,
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.OBJECTIVES: To determine the clinical effectiveness of interventions for adult ETD and to identify gaps in the evidence to inform future research.DATA SOURCES: Twelve databases were searched up to October 2012 for published and unpublished studies in English (e.g. MEDLINE from 1946, EMBASE from 1974, Biosis Previews from 1969 and Cumulative Index to Nursing and Allied Health Literature from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.REVIEW 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.LIMITATIONS: 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.STUDY REGISTRATION: This study is registered as PROSPERO CRD42012003035.FUNDING: The National Institute for Health Research Health Technology Assessment programme.",
author = "Alexis Llewellyn and Gill Norman and Melissa Harden and Andrew Coatesworth and Daniel Kimberling and Anne Schilder and Catriona McDaid",
year = "2014",
month = "7",
language = "English",
volume = "18",
pages = "1--180",
journal = "Health technology assessment",
issn = "1366-5278",
publisher = "NHS National Institute for Health Research",
number = "46",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - Interventions for adult Eustachian tube dysfunction

T2 - Health technology assessment

AU - Llewellyn, Alexis

AU - Norman, Gill

AU - Harden, Melissa

AU - Coatesworth, Andrew

AU - Kimberling, Daniel

AU - Schilder, Anne

AU - McDaid, Catriona

PY - 2014/7

Y1 - 2014/7

N2 - 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.OBJECTIVES: To determine the clinical effectiveness of interventions for adult ETD and to identify gaps in the evidence to inform future research.DATA SOURCES: 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.REVIEW 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.LIMITATIONS: 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.STUDY REGISTRATION: This study is registered as PROSPERO CRD42012003035.FUNDING: The National Institute for Health Research Health Technology Assessment programme.

AB - 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.OBJECTIVES: To determine the clinical effectiveness of interventions for adult ETD and to identify gaps in the evidence to inform future research.DATA SOURCES: 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.REVIEW 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.LIMITATIONS: 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.STUDY REGISTRATION: This study is registered as PROSPERO CRD42012003035.FUNDING: The National Institute for Health Research Health Technology Assessment programme.

M3 - Article

VL - 18

SP - 1

EP - 180

JO - Health technology assessment

JF - Health technology assessment

SN - 1366-5278

IS - 46

ER -