Chronic Eustachian Tube Dysfunction Research Articles (Page 1)

Studies have shown balloon dilation of the Eustachian tube (BDET) to play a beneficial role in the treatment of obstructive Eustachian tube (ET) dysfunction in adults. This analysis was undertaken to clarify this role. Cochrane Central Register of Controlled Trials, PubMed, Embase Ovid, ClinicalTrials.gov, WHO-ICTRP, EU Clinical Trials Register, and Google Scholar. This review analyzed randomized controlled trials published through 29 February 2024, updated on 11 January 2025, comparing the effects of BDET with no treatment, medical treatment, or auto-inflation exercises. Outcomes included improvement in tympanogram, decrease in air-bone gap on audiometry, new ability to perform Valsalva, otoscopic confirmation of improvement in tympanic membrane retraction, or new documented mobility of the membrane on pneumatic otoscopy. Eleven trials were analyzed, four excluded with reasons and seven included in the analysis. On analysis of 315 participants from three trials who underwent BDET in comparison to control, the relative risk of benefit of post-operatively reaching Type A tympanogram was 4.68 (2.88-7.51) in comparison to control. BDET was also seen to offer significantly more closure in air-bone gap when performed along with tympanoplasty in patients with adhesive otitis media at both 3-month (air-bone gap closure of 3.82 dB [0.47-7.17 dB]) and 6-month (air-bone gap closure of 4.06 dB [1.78-6.34 dB]). In adults with chronic ET dysfunction, BDET increased the chance of achieving a Type A tympanogram curve and significantly improved air-bone gap closure when performed along with cartilage tympanoplasty. 1a.

Comparison of tympanostomy tube insertion with and without radiofrequency ablation eustachian tuboplasty for treating chronic otitis media with effusion.

Balloon dilation eustachian tuboplasty (BDET) has gained popularity as a treatment modality for chronic eustachian tube dysfunction (ETD) in both adults and children. Although its safety and efficacy in the adult population have been well described, very few large-sample studies assessing its safety profile have been performed in the pediatric population. This study serves as a follow-up to a previously published analysis assessing the safety of BDET in the pediatric population. Retrospective chart review of 71 pediatric patients (139 ears) aged 11 ± 7 years who underwent BDET from 2019 to 2023. Medical records were reviewed from the extended postoperative period. A standardized grading scale that assesses severity of surgical complications was used. A total of five minor complications (7%) were noted. These included transient postoperative tinnitus, hyperacusis, otalgia, nausea, and epistaxis. There were no major complications requiring repeat intervention or need for imaging or hospital admission. In all cases, these symptoms had resolved in the postoperative time frame, with majority of them demonstrating complete resolution before the first postoperative visit.When combining these findings with the previously published paper by the same institution, the overall complication rate is 6.1% with 114 total patients. All complications between both papers are considered minor with no long-term effects. In this retrospective analysis, BDET is shown to be a relatively safe procedure when performed in the pediatric population. Upon review of the literature, this is the largest safety analysis of exclusively pediatric patients who underwent BDET. 4.

The Eustachian tube (ET) is a bottleneck when it comes to middle ear (ME) health. If its function is impaired, this can lead to serious consequences for the patient, such as hearing problems or deafness. Therefore, this study investigated a tapered nitinol stent (3-5 mm × 14 mm) for the human ET as a potential new permanent treatment for chronic Eustachian tube dysfunction (ETD) and thus ME ventilation disorders. The self-expanding stent was inserted unilaterally into the ET of 24 sheep with observation periods of 3, 6, and 12 months. Local tissue effects and the safety of the stent insertion were analyzed based on regular endoscopic checks, weekly tympanometry measurements, final imaging, and histological examinations. The animals showed no stent-related health restrictions. However, the individual anatomy and stenting procedure had an influence on the results. The tissue reaction in the endoscopic examinations was mild even though no concomitant antibiotics were administered. After all three monitoring periods, stented ETs had a significantly larger ET lumen than the non-stented contralateral ETs. However, tissue growth was detected in the stent. Overall, the first long-term study on an ET stent showed that the tapered ET stent could be a promising treatment option for ETD.

To determine whether balloon dilation of Eustachian tube (BDET) improves postoperative audiology and quality of life scores in children with chronic Eustachian tube dysfunction. Retrospective study. Tertiary care pediatric center. Eligible participants were patients 8 years or older, with a history of 2 prior tubes placement. Group 1-patients completed pre-and post-Eustachian Tube Dysfunction Quality of Life Survey (ETDQ-7) survey scores, Group 2-patients had available pre- and postdilation tympanogram data (TD), and Group 3-patients had both ETDQ-7 survey and TD. The average time for the first and subsequent follow-ups was 3.8 and 12.9 months, respectively. A total of 43 patients (85 ears) underwent BDET. The mean age was 13.3 years (8-18 years). Twenty-four patients were male (55.8%) and over 80% were Caucasian. The average mean ETDQ-7 score before and after dilation was 3.9 and 2.5, respectively. Ninety-three percent experienced improvement of their postoperative ETDQ-7 scores and 53% had normal postdilation ETDQ-7 score (P < .0001). Thirty-seven ears in Group 2 (60.7%) had improvement in postdilation TD. A greater proportion of ears showed improvement of 62.3% with a 95% confidence interval (CI) [50.1%-74.5%] compared to 37.7% without improvement, 95% CI [25.5%-49.87%]. Ears with type A or B TD were more likely to show improvement than ears with type C, perforated, or with tubes (P < .0001). Eighteen out of 30 ears in Group 3 (60%) experienced an improvement in both ETDQ-7 and tympanogram. BDET is a safe, efficacious alternative to tubes in selected pediatric patients.

Objective:Eustachian Tube Balloon Dilation (ETBD) represents an innovative therapeutic approach for chronic Eustachian tube dysfunction (CETD), a common disease in children. Some evidence of a benefit of ETBD in the adults exist in contrast to sparse reports in children. The objective was to analyze short- and long-term outcome of ETBD in children with CETD.Methods:A retrospective chart-review was performed in a cohort of 19 children (mean age 13 years, 7-17) who underwent ETBD. The following parameters were analyzed: tubomanometry (R-value), tympanogram, hearing (CPT-AMA, Air-bone gap [ABG]), Eustachian Tube Score (ETS and ETS-7), and Eustachian Tube Disease questionnaire (ETDQ).Results:Twenty-four ears were dilated (in 5 patients subsequently after successful first intervention) and grouped as A (17) without and B (7) with additional T-tube insertion. Most children suffered from either chronic otitis media with effusion or chronic perforation (12, 63%), the remainder comprising recurrent otitis media, adhesive otitis media and CETD with barotrauma. Mean duration of symptoms were 7/8.2 years and mean follow-up 13.7/11.1 months. Eighty percent of patients reported a subjective benefit. Accordingly, the R-value, ETS, and ETS-7 were significantly (P < .05) improved. Tympanometry, CPT-AMA and ABG showed a positive trend, but the result was not significant. Tympanic retraction remained largely the same; a spontaneous closure of a chronic tympanic perforation was seen in 1 of 3 cases.Conclusions:The high subjective benefit and some significant objective improvement warrants further analysis of ETBD as part of the therapeutic management in pediatric CETD.

Hyperplasia of the pharyngeal tonsils is to be considered pathologic when nasopharyngeal symptoms of mechanical obstruction and/or chronic inflammation occur. Chronic Eustachian tube dysfunction can result in various middle ear diseases such as conductive hearing loss, cholesteatoma, and recurrent acute otitis media. During examination, attention should be paid to the presence of adenoid facies (long face syndrome), with apermanently open mouth and visible tip of the tongue. In the case of severe symptoms and/or failure of conservative treatment, adenoidectomy is usually performed on an outpatient basis. Conventional curettage remains the established standard treatment in Germany. Histologic evaluation is indicated for clinical evidence of mucopolysaccharidoses. Due to the risk of hemorrhage, the preoperative bleeding questionnaire, which is obligatory before every pediatric surgery, is referred to. Recurrence of adenoids is possible despite correct adenoidectomy. Before discharge home, otorhinolaryngologic inspection of the nasopharynx for secondary bleeding should be performed and anesthesiologic clearance obtained.

Background:Obstructive Eustachian tube dysfunction in adults is common. The purpose of this study was to examine whether balloon dilation of the Eustachian tube can improve ventilation of the middle ear among adult patients with mild chronic Eustachian tube dysfunction.Methods:This study included patients aged ≥18 years with unilateral chronic Eustachian tube dysfunction confirmed with an abnormal tympanometry and a retracted tympanic membrane. Patients were treated daily with nasal steroid spray and Valsalva maneuver for 2 months. If Eustachian tube dysfunction persisted, they were enrolled in the study and randomized to balloon dilation of the Eustachian tube or control. All patients underwent otomicroscopy, tympanometry, pure-tone audiometry and the Eustachian Tube Dysfunction Questionnaire-7. Follow-up visits were completed at 3 weeks, 3 months, and 6 months.Results:In total, 24 patients completed the study (13 balloon dilation of the Eustachian tube, 11 control). The balloon dilation of the Eustachian tube group showed normalization from retraction or serous otitis media in 9 out of 13 patients (P = .0006) compared to 0 out of 11 patients in the control group. In the balloon dilation of the Eustachian tube group, 9 out of 13 patients showed an improvement in tympanometry from B to C/A or from C to A (P = .04) compared to 3 out of 11 patients in the control group. The audiometric data showed no difference (P = .38). There was no significant difference in mean Eustachian Tube Dysfunction Questionnaire-7 score between the two groups (P = .35). In the balloon dilation of the Eustachian tube group, 69% answered that they had benefitted from the treatment.Conclusion:The procedure is feasible and no complications were reported. The study indicates that balloon dilation of the Eustachian tube may be a beneficial treatment in a selected group of adult patients with mild chronic Eustachian tube dysfunction.

Background:Eustachian tube dysfunction affects from 1% to 5% of adults. This study evaluates the effectiveness of balloon dilation of eustachian tube for treating nonselected patients with eustachian tube dysfunction in a long term.Methods:We evaluated all balloon dilation of eustachian tube operations at Turku University Hospital from 2013 to 2016. The data from 107 patients and 167 ears were collected retrospectively and a questionnaire was sent to these patients regarding their symptoms.Results:An evident reduction of the symptoms was noticed. Aural fullness, otalgia, recurrent acute otitis media, or otitis media with effusion as well as symptoms from changes to ambient pressure and the ability to do the Valsalva maneuver were significantly improved. The mean follow-up time with the questionnaire was 33 months. Of patients, 80% (36/45) reported long-term reduction of symptoms.Conclusions:In our study, balloon dilation of eustachian tube seems to have reduced symptoms of eustachian tube dysfunction and the results appear to be long lasting.

Not many imaging techniques have been reported in Eustachian tube imaging. To investigate the role of selective Eustachian tubography (SET) and Valsalva computed tomography (CT) in patients who underwent Eustachian tube balloon dilation (ETBD). Eligible patients were aged 18 years and older with chronic Eustachian tube dysfunction who had failed medical treatment. On the day of the procedure, Valsalva CT and SET were performed. Participants underwent fluoroscopic ETBD with a 6×20-mm balloon catheter. Clinical examinations to check for the ability to perform the Valsalva maneuver and ETDQ-7 score change were conducted at one week and then at one, two, and six months. Follow-up Valsalva CT was performed in the one-month follow-up. A total of 30 ears in 23 patients (16 right ears, 14 left ears; 10 women, 13 men) underwent ETBD from August 2018 to November 2019. Positive CT patency was higher in follow-up Valsalva CT than baseline Valsalva CT (40% and 23.3%, respectively) (P = 0.006). In SET, positive patency was observed in 13 of 25 ears. Response to balloon dilation was observed in 18 of 25 patients. Clinical success was achieved in 16 of 27 ears. Response to balloon dilation was the only significant predictor of clinical success (P = 0.012). SET depicted the lumen of the Eustachian tube; thereby, it could be a potentially valuable tool in ETBD. Valsalva CT provides additional information about the cartilaginous portion of the Eustachian tube.

BackgroundOtalgia is a frequent reason for medical consultation. In Africa, few studies have been devoted to the epidemiology and aetiology of otalgia. To our knowledge, no study has been carried out in Chad.AimsThe objective of this study is to describe the epidemiological, clinical and aetiological aspects of otalgia in Chadian hospitals.MethodsThis was a prospective, descriptive and analytical study conducted at the Renaissance University Hospital from January to August 2020. All the patients that were consulting in the ENT department for otalgia were included. Data was analysed using SPSS version 26. The chi-square test was used to compare the results.Results88 (22.3%) of the 395 patients suffered from otalgia. Their sex ratio was 1:1 (M:F). Their average age was 30.4 ± 19.5 years. The median age was 31.5 years with extremes from 1 to 70 years. Children (1–18 years) represented 30.7% of the cases. The average time of consultation was 27.8 ± 35.0 days. Otalgia was associated with deafness in 33% of the cases and 29.5% of the patients have used cotton swabs. Otogenic otalgia in 73.9% of the cases was significantly more frequent in children (92.6% versus 65.6%, P =0.008). Otogenic otalgia was related to otitis externa, chronic otitis media and Eustachian tube dysfunction in 44.6%, 21.5%, and 13.9% of cases respectively. The aetiologies of the referred otalgias were angina and rhinopharyngitis (30.4%), trigeminal neuralgia (21.7%) and oral cavity, pharyngeal and laryngeal cancer (21.7%).ConclusionOtalgia is a frequent reason for medical consultation at any age regardless of sex. However, ear infections are more frequent in children. Referred otalgias predominate in adults, dominated by pharyngeal infections, trigeminal neuralgia and oral cavity, pharyngeal and laryngeal cancers.

Abstract Background Otitis media with effusion (OME) is a worldwide major health problem for both children and adult, who have a history of chronic eustachian tube dysfunction. Aim of the Work to review the effect of intratympanic injection of steroids in treatment of chronic otitis media with effusion (persistent more than 3 months after failure to medical treatment [e.g. local &amp; systemic steroids or decongestants] or surgical ventilation tubes). Material and Methods This systematic review was done as a collective analysis of 5 retrospective and prospective cohort studies done on patients with OME. Studies on Patients who were diagnosed with chronic otitis media with effusion not responding to conventional methods of treatment. Results The data analysed and results showed an improvement of 41.2% of the cases treated with intratympanic injection of steroids compared to 11% improvement in cases treated by conventional medical methods with a relative improvement around 6.4 folds to intratympanic injection of steroids over medical treatment. All of these studies have shown that there are more advantages of directed ototopical steroid therapy over systemic therapy. Topical medications often have limited systemic effects due to their limited systemic uptake. It may be less expensive as compared to systemic medications. Conclusion Intratympanic injection of long acting steroids has good effect in management of OME resistant to medical and surgical treatment and has superior effect and high rate of recovery on local nasal steroid spray. In children combination of ventilation tubes and intratymapnic injection of steroids is the best known modality of treatment. Further studies are needed to evaluate the best medical treatment of chronic OME.

With increased focus on surgical management of the eustachian tube, clarifying management decisions benefits patients and surgeons. In this study, we examine the value of repeating the balloon dilation of the eustachian tube (BDET) procedure in patients who did not improve after the initial BDET. Level IV retrospective review of 145 BDETs performed on 86 patients between January 1, 2014, and May 1, 2019, identified 10 patients who underwent BDET more than once. Managed care community otolaryngology practice. Demographic and outcome data were collected on both single and repeat BDET cohorts. The Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7) was used as the primary outcome measure when comparing single vs repeat BDET cohorts. Generally, the 2 cohorts were similar in terms of sex and age distribution. Tobacco use and radioallergosorbent test-positive results were greater proportionally in the repeat BDET cohort. Preoperative ETDQ-7 scores were similar in both cohorts. Single BDET patients overall showed significant improvement in ETDQ-7 scores. ETDQ-7 scores for repeat BDET patients who did not improve after the first procedure similarly did not demonstrate improvement after the second procedure. Inevitably, some patients will not improve after an initial BDET procedure. The utility of a repeated BDET procedure should be considered in determining how to manage such failures. The results of this limited study suggest that patients who fail to improve meaningfully on ETDQ-7 scores after the initial procedure are unlikely to show substantial improvements after a repeated procedure.

ObjectivesMultiple 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 sourcesA 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.MethodsA 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.ResultsThree 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.ConclusionsBased 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.

Determine the safety and efficacy of balloon dilation of the Eustachian tube (ET) in pediatric patients. Retrospective matched cohort study. Tertiary medical center. Pediatric patients (<18 yr) with persistent (>1.5 yr) chronic Eustachian tube dysfunction (ETD) with previous tympanostomy tube (TT) insertion versus matched controls. Balloon dilation of the cartilaginous ET (BDET) was performed using concomitant myringotomy with/without tube placement and adjunctive procedures if indicated versus controls (TT). Otitis media with effusion (OME)/retraction with need for additional tube, tympanogram, audiogram, otomicroscopy, ET mucosal inflammation/opening score, and Valsalva maneuver. Forty six ETs (26 patients), ages 7 to 17 years (mean 12.5) underwent BDET. Mean follow-up was 2.3 years (standard deviation [SD], 1.1; range, 6 mo-5 yr). Significant improvements were observed for all measures. Tympanic membranes were healthy in 9% preoperatively, 38% at 6 months, 55% at 12 months, and 93% at 36 months postoperatively. Tympanograms improved to type A in 50% at 6 months, 59% at 12 months, and 85% at 36 months. Mean scores of mucosal inflammation declined from 3.2 (±0.6) preoperatively to 2.5 (±0.7) at 6 months and 1.7 (±0.6) at 36 months postoperatively. BDET had lower risk of failure versus TT insertion (adjusted hazard ratio [HR] 0.26; 95% confidence interval [CI]: 0.10, 0.70; p = 0.007). Probability of being failure free at 2 years was 87% (95% CI: 70, 94%) after BDET and 56% (95% CI: 40, 70%) after TT insertions. BDET is a safe and possibly effective procedure in selected pediatric patients with chronic ETD.

Balloon eustachian tuboplasty (BET) is a promising therapeutic option for eustachian tube (ET) dysfunction. However, data are lacking on the effect of BET in adults with symptoms of chronic ET dysfunction but without a contributing pathology. This study investigated the effect of BET in adult patients with only symptoms of chronic ET dysfunction. This prospective clinical trial included adult patients with aerated physiological middle ears and symptoms of ET dysfunction for more than 6 months. Compliance with follow-up was 93.3%. We evaluated the effects of BET with tympanometry, assessment of the Valsalva or Toynbee maneuver with tympanometry verification, a Eustachian Tube Dysfunction Questionnaire (ETDQ-7), and pure-tone audiometry. Data were recorded 1 day before surgery and 2, 6, and 12 months after BET. Therapy was considered successful when the patient exhibited a newly acquired ability to perform the Valsalva or Toynbee maneuver or when the ETDQ-7 score improved by 20% or more. We included 14 ears in the analysis. After 2, 6, and 12 months, therapy was successful, according to the ETDQ-7, in 11/14 (78.6%; 95% CI: 48.8-94.3), 13/14 (92.9%; 95% CI: 64.2-99.6), and 12/14 (85.7%; 95% CI: 56.2-97.5) ears, respectively. These results were statistically significant. The ETDQ-7 scores also significantly decreased at 2, 6, and 12 months after the BET, when any change was observed. All patients experienced improvement. Only 1 patient reported temporary deterioration after 2 months. Treatment was more frequently successful in patients without nasal polyps or pollinosis. Adults with only symptoms of chronic ET dysfunction benefitted more and had longer lasting results from BET, compared to patients with pathologies caused by ET dysfunction. Balloon eustachian tuboplasty could be recommended for these patients.

Background and Aim: Balloon eustachian tub­oplasty (BET) is a recently developed and app­roved method for management of chronic eus­tachian tube dysfunction (ETD). In the present study we aimed to evaluate the safety and effi­cacy of this method in Iranian samples. Methods: In this prospective case-series study, we included 15 adult patients with chronic ETD who were resistant to previous medical manage­ments and/or ventilation tube use. All patients underwent baseline audiometry (pure tone audio­metry and tympanometry), Valsalva maneuver, EDT questionnaire-7 (ETDQ-7), and physical examination. Three to six months after the BET procedure, all patients underwent four evaluation methods again. Results: We found a significant improvement in the mean ETDQ-7 scores comparing pre- and post-test scores (p &lt; 0.0001). There was also a statistically significant decrease in the average air-bone gap from 40.55 at baseline to 27.22 after treatment (p &lt; 0.001). In the Valsalva test, 17 out of 18 study ears (92.3%) had a positive result after the surgery. Under tympanographic evalu­ation, 9 ears (50%) reported a conversion from type B to type A after treatment, 2 ears (11%) had a conversion from type B to C, and 7 ears (39%) showed no any change and stayed in type B after BET. Conclusion: As a novel method in Iran, BET can be an alternative safe treatment option for chro­nic ETD. Keywords: Balloon eustachian tuboplasty; eustachian tube dysfunction; Iranian

The objective of this study is to demonstrate that balloon eustachian tuboplasty (BET) is safe and had limited complications in the pediatric patient population. Retrospective chart review. This study analyzed the medical records of 43 consecutive encounters of patients under the age of 18 years old who underwent attempted BET. Charts of patients' postoperative appointments and appointments 30 days following the procedure were reviewed. Any complications that were reported by the surgeons' operative report or documented postoperatively were stratified by the Classification of Surgical Complications as outlined by the American College of Surgeons. Additional data points that were analyzed included concomitant surgical procedures, estimated blood loss, and demographic information. A cohort of 43 pediatric patient encounters were investigated. There was a total of two complications from BET (4.7%) and one aborted case. The complications included epistaxis controlled with oxymetazoline and pressure, and vertigo that was later attributed to vestibular migraines. One case was aborted due to inadequate exposure. The average age of patients evaluated was 12.4 ± 3.2 years old with a range of 6.6 to 17.7 years old. In this retrospective cohort, BET was demonstrated to be a relatively safe intervention with an overall complication rate of 4.7% in patients as young as 6.6 years old with recurrent or chronic eustachian tube dysfunction and/or related issues. 4 Laryngoscope, 131:1657-1662, 2021.

Eustachian tube dysfunction (ETD) presents with symptoms of aural fullness and pressure, muffled hearing, tinnitus, and otalgia. When severe, it can lead to many common ear disorders such as otitis media with effusion, tympanic membrane retraction/perforation, and cholesteatoma. These diseases are prevalent in both the pediatric and adult population and significantly impact quality of life. The pathophysiology of ETD in the absence of an obstructive lesion has long been debated but is thought to be related to functional obstruction (i.e., inefficient tensor veli palatini muscle) and/or nasal cavity and nasopharyngeal inflammation. In the acute setting, the most common cause of nasal inflammation is an upper respiratory infection. When symptoms become chronic, however, the inflammation is thought to be associated with nasal irritants such as nasal allergens, i.e., allergic rhinitis (AR). The purpose of this review is to summarize our current understanding of the relationship between allergy and ETD. Past studies are either lacking or have reported equivocal findings regarding the relationship between allergy and ETD, and the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis has deemed the current level of evidence linking AR and ETD as low quality. A more recent study using a large adult population dataset did support an association between AR and ETD, but did not find that all cases of ETD are related to allergies. Furthermore, current evidence suggests that the use of medications that can decrease intranasal inflammation, such as intranasal corticosteroids or oral antihistamines, does not result in significant symptomatic improvement in patients with ETD. However, these studies included all patients with ETD, and evidence is lacking regarding the treatment effect of these medications on the subset of patients with concurrent AR and ETD. Current best evidence does support an association between AR and ETD; however, not all patients with ETD suffer from AR, and vice versa. Further research is necessary to understand the mechanism behind this positive association and to elucidate the cause of chronic ETD in patients without associated allergies.

The Eustachian tube plays a crucial role in pressure equalization between the middle ear and ambient pressure for fast and large pressure differences. In patients with chronic Eustachian tube dysfunction, Eustachian tube balloon dilatation is increasingly used as surgical therapy. Subjectively, many patients report an improvement of the symptoms postoperatively. Hence, there is a need to objectively measure this effect. The objectivity of Eustachian tube balloon dilatation was evaluated using a precise method of measuring Eustachian tube function. In a hypo/hyperbaric pressure chamber, 23 ears in 13 patients were exposed to a standardized profile of compression and decompression before Eustachian tube balloon dilatation and 4 weeks afterwards. Standardized parameters of Eustachian tube function were determined and statistically compared before and 4 weeks after intervention. In addition, an Eustachian Tube Dysfunction Questionnaire-7 (ETDQ7) questionnaire was completed beforehand and 4 weeks postoperatively to determine subjective surgical success. The results from the ETDQ7 questionnaire showed a significant improvement in symptoms after Eustachian tube balloon dilatation (p = 0.0002). Objective measurements results showed a significant reduction of the Eustachian tube opening pressure during pressure decrease 4 weeks after intervention (p = 0.0012). Eustachian tube balloon dilatation significantly reduced Eustachian tube opening pressure, in addition to subjective improvement of symptoms determined by ETDQ7.