Eustachian Tuboplasty as an Adjunct Treatment to Concurrent Tympanostomy Tube Insertion for Otitis Media With...

Chronic otitis media with effusion (COME) is defined as an accumulation of nonpurulent fluid within the middle ear space without evidence of an acute infection. A primary factor in the development of COME is eustachian tube dysfunction. Tympanostomy tube insertion (TTI) has long been an established and effective means of treating OME; eustachian tuboplasty (ET) has emerged as another treatment measure. There are limited studies that combine TTI with ET and compare the effectiveness of combined treatments to TTI alone. The focus of this systematic review is to assess if the adjunctive treatment of ET with TTI is superior to TTI.

A study question was identified, and inclusion and exclusion criteria were generated. Search criteria were defined by two independent reviewers working in parallel, and PubMed/MEDLINE, Embase, Scopus, and Cochrane/CENTRAL databases were searched to assess possible studies. Ultimately, four cohort studies were used in data analysis. Outcome data was extracted and pooled whenever possible across the studies to generate a meta-analysis and narrative synthesis.

A total of 294 ears were assessed and primary outcome data of ETDQ-7, Air-Bone-Gap Reduction, and symptom recurrence were assessed using pooled mean difference and pooled risk reduction comparing between the ET + TTI and TTI groups. All outcomes appeared to favor ET + TTI; however, heterogeneity was present between the studies. The ET + TTI group had an average recurrence of symptoms at 9.9% and the TTI group had an average recurrence of symptoms at 24.9% (p = 0.02).

This analysis suggests there is a clinically significant reduction in recurrence of symptoms when ET is added to TTI as an adjunctive treatment for OME in adults. Additional studies with adequate control groups need to be conducted to be able to confidently state that concurrent ET with TTI is better than TTI alone.