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.