Eustachian tube dysfunction (ETD) is the result of a combination of factors that interfere with the mucosal functional or cartilaginous structures. Failure to open the eustachian tubes can cause aural pain, pressure in the ears, muffled hearing, crackling/popping sounds in the ears; symptoms associated with failure to equalise pressure in the middle ear. The exact pathophysiology is not fully understood but negative pressure in the middle ear appears to be the key factor. There is no standardised method to objectify ETD, which makes evaluating the effectiveness of treatments difficult. Treatments include medical (nasal sprays) and surgical (grommets). BET has emerged as a possible novel alternative to grommets or laser turbinoplasty. This involves a transnasal endoscopic approach under a short-acting general anaesthesia, feeding a balloon catheter into the eustachian tube with the aim to widen the tube and improve its function. This systematic review focused on 15 articles which satisfied their selection criteria. Some of the papers reviewed here were similar to the ones included in the appraisal of the BET procedure by NICE in 2011. The review concludes that BET has few adverse events, and these were mostly mild (2%). It also suggests that it seems favourable to reduce symptoms of ETD and diminish ETD severity scores. It ends on the note that further research in randomised, homogenous populations, using a solid combination of available diagnostic instruments and symptom scores pre- and post-op, is recommended. 

Treatment of eustachian tube dysfunction with balloon dilation: a systematic review.
Huisman J, Verdam F, Stegeman I, de Ru J.
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Gentle Wong

Guy's and St Thomas' Hospitals, UK.

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