Meta-analysis Of Efficacy And Safety Of Eustachian Tuboplasty In Treating Eustachian Tube Dysfunction

Objective:To evaluate efficacy and safety of eustachian tuboplasty in treating eustachian tube dysfunction by systematic review and the difference of laser eustachian tuboplasty and balloon eustachian tuboplasty were further compared,and it will help to provide valid evidences for evidence-based medicine in treating eustachian tube dysfunction.Methods:Electronic search strategy was carried out,searching CBM,CNKI,WanFang database,VIP database,PubMed database,EMBASE database and MEDLINE database to collect data on eustachian tuboplasty and relevant magazines,conference,grey literature and references retrieved manually.The searching time until December 2016.The included studies were evaluated,incluing subjective symptom improvement rate,type A tympanogram conversion rate,Valsalva maneuver completion rate and complication rate,and further to compare the difference of laser eustachian tuboplasty and balloon eustachian tuboplasty.All statistical analysis was conducted with R3.3.2.Results:A total of 20 case series studies containing 614 patients(815 tubes)finally included.Patients’ subjecttive symptom was described in ten studies.Seventeen studies reported the result of tympanogram.Six studies reported the Valsalva maneuver completion rate and nine studies reported the specific complication rate.A total of subjective symptom improvement rate,type A tympanogram conversion rate,valsalva maneuver completionrate and complication rate were 96%(95%CI:0.92~0.99),65%(95%CI:0.48~0.79),79%(95%CI:0.65~0.88)and 6%(95%CI:0.02~0.12),respectively.The subgroup analysis showed that subjective symptom improvement rate were 98%(95%CI:0.93~1.00)and94%(95%CI:0.87~0.99),P>0.05 for laser eustachian tuboplasty and balloon eustachian tuboplasty,respectively.The type A tympanogram conversion rate were 41%(95%CI:0.18~0.68)and 76%(95%CI:0.55~0.90),P<0.05 for laser eustachian tuboplasty and balloon eustachian tuboplasty,respectively.The Valsalva maneuver completion rate were70%(95%CI:0.59~0.79)and 91%(95%CI:0.63~0.98),P<0.05 for laser eustachian tuboplasty and balloon eustachian tuboplasty,respectively.The complication rate were8%(95%CI:0.02~0.17)and 5%(95%CI:0.01~0.14),P>0.05 for laser eustachian tuboplasty and balloon eustachian tuboplasty,respectively.Conclusion:This existing results concluded(1)eustachian tuboplasty is significantly effective for treating chronic eustachian tube dysfuntion in adults.The subjective symptom improvement rate has no significant difference between balloon eustachian tuboplasty and laser eustachian tuboplasty.But balloon eustachian tuboplasty lead to higer type A tympanogram conversion rate and Valsalva maneuver completion rate than laser eustachian tuboplasty.Consideration may be associated with middle ear function preoperative and the way of recovery and the length of recovery time postoperation.(2)eustachian tuboplasty is safe and feasible for treating dilatory eustachian tube dysfuntion in adults.The complication rate has no significant difference between balloon eustachian tuboplasty and laser eustachian tuboplasty and no serious complications occurred.