Saniasiaya Jeyasakthy, Kulasegarah Jeyanthi, Narayanan Prepageran
Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.
Ann Otol Rhinol Laryngol. 2022 Jul;131(7):797-804. doi: 10.1177/00034894211041340. Epub 2021 Aug 22.
Eustachian tube dysfunction (ETD) is a chronic entity that has been historically managed with adenoidectomy and ventilation tube insertion. Recently, balloon dilation of the eustachian tube has shown promising results in recalcitrant eustachian tube dysfunction. We reviewed the literature to determine the outcome of eustachian tube balloon dilation in children.
A literature search was conducted for the period from 1990 to 2020 by searching several databases over a 1-month period (January 2021) according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews for Interventions. Primary outcome was defined as the success of the intervention determined by the resolution of symptoms, and secondary outcome was determined by revisions surgery and presence of complications.
Only 7 articles were identified based on our objectives and selection criteria. All studies included are retrospective cohort case series (Level IV) and 1 cohort of matched controls (Level III). A total of 284 patients were included in this review, with a mean age of 7.8 years. A total of 463 balloon dilation were performed either bilaterally or unilaterally. The most common finding of ETD is middle ear effusion in 5 studies. Balloon dilation of eustachian tube was second-line treatment in 6 studies and first-line treatment in 1 study. Improvement of symptoms was identified in all studies through various assessments performed. Revision surgery was performed in 1 study with no major complications reported.
Balloon dilation of the eustachian tube may be considered as an alternative procedure following failed standard treatment in children. The quality of evidence is inadequate to recommend widespread use of the technique until a better-quality study has been completed. Future randomized controlled studies with a large sample size are warranted to determine the efficacy of this procedure amongst children.
咽鼓管功能障碍（ETD）是一种慢性疾病，历来通过腺样体切除术和置放通气管进行治疗。最近，咽鼓管球囊扩张术在顽固性咽鼓管功能障碍的治疗中显示出了有前景的效果。我们回顾了相关文献，以确定儿童咽鼓管球囊扩张术的治疗结果。
根据系统评价和Meta分析的首选报告项目指南以及Cochrane干预措施系统评价手册，于2021年1月在1个月的时间内检索了多个数据库，对1990年至2020年期间的文献进行搜索。主要结局定义为通过症状缓解确定的干预成功，次要结局由翻修手术和并发症的发生情况确定。
根据我们的目标和选择标准，仅鉴定出7篇文章。所有纳入的研究均为回顾性队列病例系列（IV级）和1个匹配对照队列（III级）。本综述共纳入284例患者，平均年龄7.8岁。共进行了463次双侧或单侧球囊扩张术。5项研究中ETD最常见的表现是中耳积液。6项研究中咽鼓管球囊扩张术为二线治疗，1项研究中为一线治疗。通过各种评估，所有研究均发现症状有所改善。1项研究进行了翻修手术，未报告重大并发症。
在儿童标准治疗失败后，咽鼓管球囊扩张术可被视为一种替代治疗方法。在完成质量更高的研究之前，证据质量不足以推荐广泛使用该技术。未来有必要进行大样本量的随机对照研究，以确定该手术在儿童中的疗效。
