{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:33:52Z","timestamp":1787747632565,"version":"build-2784847793"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2014,2,27]],"date-time":"2014-02-27T00:00:00Z","timestamp":1393459200000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The <jats:styled-content style=\"fixed-case\">H<\/jats:styled-content>ealth <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>echnology <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ssessment programme commissioned a wide\u2010ranging review of treatments for adult <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>ustachian tube dysfunction. Treatments range from advice and observation and pharmacological treatments to surgical options.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>(i) To assess the evidence for interventions for adults with a clinical diagnosis of <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>ustachian tube dysfunction and (ii) to identify priorities for future research.<\/jats:p><\/jats:sec><jats:sec><jats:title>Type of review<\/jats:title><jats:p>Systematic review (<jats:styled-content style=\"fixed-case\">PROSPERO<\/jats:styled-content> registration <jats:styled-content style=\"fixed-case\">CRD<\/jats:styled-content>42012003035) adhering to <jats:styled-content style=\"fixed-case\">PRISMA<\/jats:styled-content> guidance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search<\/jats:title><jats:p>An extensive search of 15 databases including <jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> EMBASE<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">CENTRAL<\/jats:styled-content> (up to <jats:styled-content style=\"fixed-case\">O<\/jats:styled-content>ctober 2012).<\/jats:p><\/jats:sec><jats:sec><jats:title>Evaluation method<\/jats:title><jats:p>Controlled and uncontrolled studies of interventions for adult <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>ustachian tube dysfunction were included. Because of insufficient data, the protocol was amended to also include controlled studies with mixed adult\/child populations. Risk of bias was assessed. Narrative synthesis was employed due to high clinical heterogeneity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Interventions assessed were pharmacological treatments [two randomised controlled trials (<jats:styled-content style=\"fixed-case\">RCTs<\/jats:styled-content>), one controlled non\u2010randomised trial (<jats:styled-content style=\"fixed-case\">CCT<\/jats:styled-content>), 159 patients]; mechanical pressure equalisation devices (one randomised controlled trial, one <jats:styled-content style=\"fixed-case\">CCT<\/jats:styled-content>, 48 patients); and surgery, including laser tuboplasty (seven case series, 192 patients), balloon dilatation (three case series, 103 patients), myringotomy without grommet insertion (two case series, 121 patients), transtubal steroids (one case series, 11 patients) and laser coagulation (one retrospective controlled study, 40 patients). All studies had high risk of bias except two pharmacological trials; one had low risk and one unclear risk. No evidence was found for many treatments. The single low risk of bias RCT (<jats:italic>n<\/jats:italic>\u00a0=\u00a091; 67% adults) showed no effect of nasal steroids and favoured placebo for improved middle ear function (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 1.20, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.91\u20131.58) and symptoms (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.07). Other studies showed improvements in middle ear function for mechanical devices, antihistamine\/ephedrine and nasal decongestant, but they had significant methodological weaknesses including insufficient length of follow\u2010up. None of the surgical studies were adequately controlled, and many reported high levels of co\u2010intervention. Therefore, observed benefits for tuboplasty and balloon dilatation in symptoms, middle ear function or hearing could not be reliably attributed to the interventions assessed. There was variability in definitions of the condition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Eustachian tube dysfunction is a poorly defined condition. Due to the limited and poor\u2010quality evidence, it is inappropriate to make conclusions on the effectiveness of any intervention; the evidence base is insufficient to guide recommendations for a trial of any particular intervention. Consensus on diagnostic criteria for Eustachian tube dysfunction is required to inform inclusion criteria of future trials.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.12220","type":"journal-article","created":{"date-parts":[[2014,1,18]],"date-time":"2014-01-18T14:01:13Z","timestamp":1390053673000},"page":"6-21","source":"Crossref","is-referenced-by-count":82,"title":["Systematic review of the limited evidence base for treatments of <scp>E<\/scp>ustachian tube dysfunction: a health technology assessment"],"prefix":"10.1111","volume":"39","author":[{"given":"G.","family":"Norman","sequence":"first","affiliation":[{"name":"Centre for Reviews and Dissemination University of York York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Llewellyn","sequence":"additional","affiliation":[{"name":"Centre for Reviews and Dissemination University of York York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Harden","sequence":"additional","affiliation":[{"name":"Centre for Reviews and Dissemination University of York York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Coatesworth","sequence":"additional","affiliation":[{"name":"York Foundation Trust York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Kimberling","sequence":"additional","affiliation":[{"name":"Gale Farm Surgery York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Schilder","sequence":"additional","affiliation":[{"name":"University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"McDaid","sequence":"additional","affiliation":[{"name":"Department of Health Sciences University of York York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,2,27]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"TewfikT.L. 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