Systematic Review of Surgical Outcomes Following Repair of Patulous Eustachian Tube

OBJECTIVE: To perform a systematic review and meta-analysis of surgical outcomes following repair of patulous Eustachian tube (PET). DATA SOURCES: Analysis of cases collected from studies published between January 1990 and December 2018 and identified using PubMed, Google Scholar, and Cochrane databases. STUDY SELECTION: Articles addressing interventions to treat PET were selected. DATA EXTRACTION: The database was searched using the keywords "patulous Eustachian tube treatment" and yielded 1,370 studies. Twenty studies were eligible for inclusion. DATA SYNTHESIS: A total of 914 cases were evaluated for surgical approach, patient outcomes, and complications. The reported techniques were categorized by the procedure type, including ventilation tube insertion, mass loading of the tympanic membrane, ET injection, plug surgery, shim surgery, tuboplasty, and ET closure. Overall PET symptom improvement were reported for ventilation tube insertion (79 cases, mean: 58%, 95% CI: 47-69%), mass loading of the tympanic membrane (43 cases, mean: 50%, 95% CI: 32-69%), ET injection (139 cases, mean: 47%, 95% CI: 38-56%), plug surgery (386 cases, mean: 81%, 95% CI: 77-85%), shim surgery (122 cases, mean: 62%, 95% CI: 53-70%), tuboplasty (105 cases, mean: 41%, 95% CI: 31-51%), and ET closure (40 cases, mean: 66%, 95% CI: 49-80%). A low incidence of minor complications was reported. CONCLUSIONS: This systematic review describes clinical outcome data following surgical management of PET. Plug surgery and shim surgery show relatively high effectiveness and safety. Further prospective studies that compare surgical approaches for PET are needed.