Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
Department of Research and Education Services, Medical University of South Carolina Libraries, Charleston, South Carolina, U.S.A.
Laryngoscope. 2022 Dec;132(12):2473-2483. doi: 10.1002/lary.30132. Epub 2022 Apr 20.
To examine the effectiveness of Eustachian tube procedures for the treatment of baro-challenge Eustachian tube dysfunction.
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, databases, including PubMed (National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and CINAHL (EBSCO), were searched for articles examining the effectiveness of Eustachian tube procedures for baro-challenge Eustachian tube dysfunction. Outcome measures included symptom resolution, ability to return to work, equalization problems (EP) scores, Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores, and pressure chamber testing parameters. Pooled meta-analysis was performed for dichotomous measures and ETDQ-7 scores.
Eleven articles with 81 patients were included. Seventy-two patients from 10 articles underwent balloon Eustachian tube dilation; nine patients in 1 study underwent laser Eustachian tuboplasty (LET). All 81 patients were preoperatively symptomatic with barometric pressure change, and 26/30 (86.7%) were unable to work due to symptoms. On meta-analysis, after balloon dilation Eustachian tuboplasty (BDET), 82.5% (n = 30 [95% confidence interval: 42%-100%]) had improvement in ability to valsalva, 79.1% (n = 16 [57.9%-94.1%]) in ability to return to work, and 84.3% (n = 69 [69.8%-94.7%]) in any symptom. Of 25 patients with individual ETDQ-7 scores, 79.1% [51.4, 96.9] had improvements after BDET. For four case series with 36 patients, ETDQ-7 scores decreased by 1.2 [0.7, 1.7] (p < 0.00001). Of 20 patients with preoperative ETDQ-7 scores >2.0, there was a mean decrease of 2.1 [1.3, 2.8] (p < 0.00001).
From the available evidence, Eustachian tube procedures appear to be effective at improving symptoms of baro-challenge Eustachian tube dysfunction. However, higher quality evidence is needed to support making definite recommendations for the use of balloon Eustachian tube dilation or LET for these patients. Laryngoscope, 132:2473-2483, 2022.
研究咽鼓管吹张术治疗气压性挑战咽鼓管功能障碍的疗效。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，检索包括 PubMed（美国国立卫生研究院国家医学图书馆）、Scopus（爱思唯尔）和 CINAHL（EBSCO）在内的数据库，以寻找评估咽鼓管吹张术治疗气压性挑战咽鼓管功能障碍疗效的文章。观察指标包括症状缓解、恢复工作能力、均衡问题（EP）评分、咽鼓管功能障碍问卷（ETDQ-7）评分和压力室测试参数。对二分类测量和 ETDQ-7 评分进行汇总荟萃分析。
纳入 11 篇文章共 81 例患者。10 篇文章中的 72 例患者接受了球囊咽鼓管扩张术；1 项研究中的 9 例患者接受了激光咽鼓管成形术（LET）。81 例患者术前均有气压变化引起的症状，26/30（86.7%）例患者因症状无法工作。球囊扩张咽鼓管成形术（BDET）后Meta 分析显示，82.5%（n=30[95%置信区间：42%-100%]）患者valsalva 功能改善，79.1%（n=16[57.9%-94.1%]）患者恢复工作能力，84.3%（n=69[69.8%-94.7%]）患者任何症状改善。25 例患者有个体 ETDQ-7 评分，其中 79.1%[51.4,96.9]例患者 BDET 后评分改善。4 项有 36 例患者的病例系列研究显示，ETDQ-7 评分降低 1.2[0.7,1.7]（p<0.00001）。20 例术前 ETDQ-7 评分>2.0 的患者，平均降低 2.1[1.3,2.8]（p<0.00001）。
根据现有证据，咽鼓管吹张术似乎可有效改善气压性挑战咽鼓管功能障碍的症状。然而，需要更高质量的证据来支持对这些患者使用球囊咽鼓管扩张术或 LET 的建议。《喉镜》，132：2473-2483，2022。
