Surgical management of Patulous Eustachian tube: A systematic review.

OBJECTIVES Patulous Eustachian tube (PET) is a challenging clinical problem with limited medical and surgical options. The current study systematically reviews the literature to determine the safety and efficacy of surgical treatments for PET. DATA SOURCES Medline, Google Scholar, and Cochrane databases. METHODS Studies evaluating the surgical management of PET were extracted based on defined inclusion criteria. Data including surgical techniques, outcomes, and complications were extracted and analyzed. RESULTS A total of 1,616 studies were retrieved from the initial search. Of these, 14 studies comprising a total of 226 patients (253 sides) met inclusion criteria and were evaluated for surgical techniques, patient outcomes, and complications. As defined by the Oxford Center for Evidence-Based Medicine (Oxford, UK), all studies were classified as level 4 evidence. The most commonly reported techniques were ET plugging (3 studies), PE tube placement (2 studies), and suture ligation (2 studies). Postoperative follow-up ranged from 2 to 60 months (mean, 20.6 months). Outcome measures varied significantly between individual studies, with overall symptom improvement reported between 22% and 100% (mean 72.4%; 95% CI, 62.5%-81.2%). A low incidence of minor complications was reported in nine of 14 studies. CONCLUSIONS Current literature evaluating the surgical management of PET is limited and comprised entirely of level 4 studies. Comparisons between techniques were not possible due to the small number of studies and variable outcome measures. Future larger studies evaluating defined outcomes and quality-of-life measures are needed to determine the comparative efficacy of surgical treatments for this challenging condition.