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Given the potential applications for balloon Eustachian tuboplasty (BET) in children, its uptake in most centres has been slow. The reasons for this are multifactorial. There are technical issues – the feasibility of obtaining the correct size balloon and manoeuvring such balloons down narrow ear canals. There are safety concerns – reports of subcutaneous emphysema in rare cases. There are efficacy concerns – how effective is it? And there is a lack of clarity about indications – given the wide range of otologic presentations that could be helped by BET, in which cases should we use it? This review aims to resolve these questions and, in that, it is partially successful. Firstly, technical concerns are, to some extent, allayed by a series of 60 patients in which the mean age is seven. Secondly, there are positive data regarding its efficacy – proving consistent efficacy of the device – although this has to be taken in the context of the preoperative indication. And most importantly, safety. A complication rate of 5.1% is acceptable, given that the stated complications include self-resolving epistaxis, self-resolving patulous tube, and self-resolving haemotympanum. Certainly, the lack of report of the more severe complications is reassuring, although there is a question of whether it will allay the fears raised by anecdotal reports of such complications. However, the question of indication is still not clear, and this article does not meaningfully clarify the situation. It can be used in glue ear but is likely not to be as effective as grommets – although the complication rate may be lower. It has not been properly compared to conservative management for glue ear. Maybe it should be used at the same time as a grommet? Maybe in recurrent cases where long-term tubes might otherwise be considered? The majority of patients in trials had normal tympanography – but it is not clear if this is for tympanic membrane retraction, or other issues like barosensitivity. The difficulty with systematic reviews and meta-analyses is that they are only as good as the studies they analyse, and the wide range of indications for this technique, and thus wide range of studies reporting its use, makes interpretation of the data difficult. It could be argued this has hampered the adoption of this technique. There is a feeling that there is still more to learn and, whilst the safety data is encouraging and applicable to wider indications.

Efficacy and safety of balloon dilation of eustachian tube in children: Systematic review and meta-analysis.
Aboueisha MA, Attia AS, McCoul ED, Carter J.
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Robert Nash

BM BCh, MA(Oxon), MRCS, MA, DOHNS, FRCS (ORL-HNS), Great Ormond Street Hospital, London, UK.

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