Balloon eustachian tuboplasty is an emerging intervention aimed at the management of eustachian tube dysfunction (ETD) and its sequelae. The authors acknowledge that ETD is a common but frequently ill-defined problem, with no well-established direct treatment. They performed a systematic review of the evidence for balloon eustachian tuboplasty, finding that no randomised controlled or case-control studies exist in the current literature. Considerable heterogeneity in the nine included studies precluded the pooling of data for meta-analysis. Results suggested a tendency to improvement of subjective (ETDQ-7 questionnaire) and objective (e.g. tympanometry) measures. However, many patients underwent adjunctive interventions, introducing a high risk of bias. No severe adverse outcomes were reported.
A safe and effective intervention for troublesome ETD is highly desirable, particularly because of the theoretical ‘upstream’ improvements in the pathogenesis of chronic middle ear disease. However at present, no high-quality evidence exists to support the use of eustachian tuboplasty. The lack of diagnostic criteria and reliable outcome measures mean that the indications for tuboplasty are currently unclear. Of course this does not mean that the technique has no value, but larger more rigorous trials are needed before widespread adoption. If proven successful, the technique could impact upon a significant number of otological conditions. Until then, informed consent should include a frank discussion of the current state of the evidence.