Prevalence and Associated Factors of Eustachian Tube Dysfunction in Allergic Rhinitis with Middle-Ear Disease-Related...

To estimate the pooled prevalence of objective eustachian tube dysfunction (ETD) or middle-ear dysfunction in allergic rhinitis (AR), to explore how this prevalence varies by operational definition and sample size, and to identify the main clinically relevant limitations that affect interpretation of the available evidence.

We searched PubMed, Embase, Scopus, Web of Science, Google Scholar, publisher platforms, and reference lists to March 2026 for original studies reporting objective ETD, abnormal tympanometry, middle-ear dysfunction, or otitis media with effusion (OME)-compatible dysfunction in AR. Manual reference tracing, duplicate removal, and independent screening by two reviewers were performed. Six studies with extractable numerator-and-denominator data were synthesized using a random-effects meta-analysis of proportions.

The six studies included 923 AR participants. Prevalence estimates ranged from 18.0% to 49.2%. The pooled prevalence was 0.36 (95% confidence interval [CI], 0.25-0.49), with substantial heterogeneity (I² = 81.8%). Outcome-definition subgrouping indicated that estimates differed according to whether dysfunction was assessed by ETD-specific tests, tympanometric OME criteria, abnormal tympanograms, or broader middle-ear disease definitions. Sensitivity analysis did not identify a single influential study.

Preliminary evidence suggests that objective ETD or middle-ear dysfunction is frequently reported in AR and may affect a clinically meaningful subset of assessed patients. However, the evidence base is small, geographically limited, and methodologically heterogeneous; therefore, the pooled estimate should be interpreted cautiously and confirmed by larger multicenter studies using standardized diagnostic criteria. Selective otologic and tympanometric assessment remains justified in AR patients with persistent nasal obstruction, severe symptoms, hearing complaints, or recurrent OME-like episodes.