Eustachian tube dysfunction is prevalent in both paediatric and adult populations. Current clinical guidelines recommend observation over topical intranasal corticosteroids for Eustachian tube dysfunction management, which remains controversial. This study aimed to systematically review randomised, controlled trials assessing topical intranasal corticosteroid efficacy in Eustachian tube dysfunction, and analyse effect through tympanometric normalisation.

PubMed, EMBASE, Web of Science and Cochrane Library databases were searched. All randomised, controlled trials assessing intranasal corticosteroids in adult or paediatric Eustachian tube dysfunction patients were included. A meta-analysis of proportions was used to evaluate tympanogram normalisation.

Of 330 results, eight randomised, controlled trials met inclusion criteria and underwent qualitative data synthesis and risk-of-bias analysis. Meta-analysis of tympanometry data from four eligible trials (n = 512 ears) revealed no significant difference in tympanometric normalisation between intranasal corticosteroids and control (odds ratio 1.21, 95% confidence interval 0.65–2.24).

Study results do not strongly support intranasal corticosteroids for Eustachian tube dysfunction. Data were limited, emphasising the need for larger, higher quality, randomised, controlled trials.

This study aimed to form astute deductions regarding the presentation, treatment and mortality of otogenic brain complications.

A systematic literature search of four medical databases (PubMed, Embase, Web of Science and Scopus) was conducted. Studies associated with otogenic brain complications were considered eligible. Fixed- and random-effects model meta-analysis was developed to assess the proportion estimate for each outcome individually.

Twenty-eight studies, with 1650 patients in total, were included. In 66 per cent of patients there was a known history of chronic otitis media. The most common symptoms were purulent otorrhoea (84 per cent), headache (65 per cent) and otalgia (45 per cent). A brain abscess was observed in 49 per cent of patients, followed by meningitis (34 per cent) and sinus thrombosis (22 per cent). A combination of surgical and conservative therapy was chosen in 84.3 per cent of cases and the mortality rate approached 11.1 per cent.

Otogenic brain complications are a possibly life-threatening condition. Prompt imaging examination may set the final diagnosis and lead to an effective treatment.

Otolaryngologists perform bilateral myringotomy and tube placement for surgical management for otitis media with effusion. This retrospective study aimed to address the extent to which the coronavirus disease 2019 pandemic and season impact the number of bilateral myringotomy and tube placement procedures performed at a tertiary care centre.

A total of 1248 charts of children who underwent bilateral myringotomy and tube placement from January 2018 through February 2021 were reviewed.

The cohort included 41.6 per cent females and 58.4 per cent males, with 63.7 per cent having private insurance. The median age at surgery was 2.6 years. The spring season had the most bilateral myringotomy and tube placement procedures per week. The number of bilateral myringotomy and tube placement procedures performed per week after the onset of the coronavirus disease 2019 pandemic was significantly lower compared to the years prior. There was no difference in number of intra-operative effusions pre-pandemic versus after the pandemic onset.

This study sheds light on the impact of the coronavirus disease 2019 pandemic and seasonality on the rates of tympanostomy tube procedures, vital for understanding the temporality of ear infections.

To assess the effect of the coronavirus disease 2019 pandemic on paediatric bilateral myringotomy and tube insertion rates in New Brunswick, Canada.

All paediatric bilateral myringotomy and tube insertion cases from 1 July 2015 through 30 June 2021 were provided by New Brunswick Medicare. The numbers of otolaryngologists, cataract surgical procedures, total hip arthroplasties and thyroidectomies were collected to assess the availability of operating theatres and otolaryngologists. Negative binomial logarithmic regressions were used for analyses.

Of the 5175 paediatric bilateral myringotomy and tube insertion cases that were included, the bilateral myringotomy and tube insertion rate significantly decreased by 2.9 times (p < 0.001) during the pandemic. Thyroidectomies, cataract surgical procedures and total hip arthroplasties did not significantly decrease. The number of otolaryngologists increased (20 vs 16–17).

Paediatric bilateral myringotomy and tube insertion rates significantly decreased during the pandemic. This cannot be accounted for by reduced otolaryngologists or operating theatre availability. The paediatric bilateral myringotomy and tube insertion rate decrease is likely due to public health measures reducing the transmission of upper respiratory tract infections, resulting in fewer indications for paediatric bilateral myringotomy and tube insertion.

To analyse the natural course of infants with otitis media with effusion who failed universal newborn hearing screening and to explore the appropriate observation period.

This retrospective cohort analysis included infants with otitis media with effusion who failed universal newborn hearing screening every 3 months for 12 months.

The average recovery time of the 155 infants was 7.08 ± 0.32 months after diagnosis. Multivariate Cox regression analysis confirmed that frequent reflux, maxillofacial deformities and initial hearing status were independent factors affecting recovery. Moreover, the cumulative recovery of most infants with mild hearing loss and infants with moderate hearing loss accompanied by frequent reflux was significantly higher at six months after diagnosis than at three months.

For most infants with mild hearing loss, as well as those with moderate hearing loss accompanied by frequent reflux, the observation period can be extended to six months after diagnosis.

Chronic or recurrent mucoid respiratory tract symptoms may be difficult to diagnose.

Ninety-two children with chronic respiratory symptoms were divided into 4 groups: 18 children with refractory asthma, 10 with bronchiectasis without dextrocardia, 18 with dextrocardia and 46 with recurrent respiratory tract infections. Except for five neonates, cytology samples were taken under general anaesthesia. Ciliary beat frequency was measured photometrically and analysed by in-house computer software.

Nasal polyps were found in one child with normal ciliary beat frequency. Twenty-six children had no beating cilia (male to female ratio, 15:11). The effect of increasing temperature on the ciliary beat frequency of the remaining 66 patients was evaluated (42 patients, more than 30°C, median, 8.3 Hz; 24 patients, 30–37°C, median, 11.8 Hz; p = 0.0003).

The measurement of ciliary beat frequency is part of the diagnostic work up of patients with persistent or recurrent respiratory tract infections.

Cleft palates are one of the most common congenital malformations. Because of the loss of Eustachian tube function, middle-ear ventilation is reduced. The aim of this study was to determine if middle-ear effusions were present at birth or at the three-month audiological evaluation.

A total of 53 children with a cleft palate were included. Data review included the results of newborn hearing screening, microscopic findings, a tympanometry, a free field audiometry and intra-operative findings.

A total of 58.4 per cent of patients had a median, 26.4 per cent had a bilateral, 11.3 per cent had a unilateral and 3.8 per cent had a limited soft palate cleft. Newborn hearing screening showed a pass in 83.1 per cent of newborns bilaterally. The first ear microscopy showed a bilateral middle-ear effusion in 90.6 per cent of cases. During cleft surgery, bilateral paracentesis was performed in all cases, and in 90.6 per cent middle-ear effusion was sucked out.

The majority of children with a cleft palate do not present with middle-ear effusion at birth. It develops within several days or weeks of life.

Advice to patients following grommet insertion and waterproofing can vary from clinician to clinician. A laboratory based experiment was performed to determine at what depth water contamination would occur through various grommet tubes.

A novel experimental ear model was developed using an artificial tympanic membrane and ventilation tubes. Water contamination was identified using an effervescent solid that reacts when in contact with water. Measures of dispersion were used to describe the results.

The average depth of water contamination was: 19.64 mm (range = 11–33 mm, standard deviation = 5.55 mm) using a Shepard grommet; 20.84 mm (range = 18–26 mm, standard deviation = 1.97 mm) with a titanium grommet; and 21.36 mm (range = 18–33 mm, standard deviation = 3.03 mm) using a T-tube. Water contamination was possible at depths of 11–33 mm. The average pressure at water effervescent activation was 0.20 kPa.

Submersion underwater at any depth with grommets is likely to lead to middle-ear contamination. These findings are concordant with clinical studies.

To assess the effect on hearing of non-functioning ventilation tubes due to blockage during the first six months post-operatively, using UK national guidelines.

A prospective, observational study was conducted on 37 children who underwent bilateral ventilation tube insertion. Air and bone conduction thresholds were measured before and following surgery, and at one, three and six months post-operatively. Tube non-function was assessed by tympanometry supported by otoscopy.

Post-operatively, an average of 21 per cent of ventilation tubes were non-functioning. Ears with non-functioning tubes had significantly (p = 0.0001) poorer mean air conduction thresholds than functioning tubes, with a magnitude of 6 dB HL. Ears with otorrhoea were most affected (15 per cent). At any one visit, the air–bone gap was closed to 10 dB or less in 76 per cent of ears. Non-functioning tubes reduced this to 56 per cent. Compared with tympanometry, otoscopy underdiagnosed tube non-function due to blockage by 22 per cent.

Non-functioning of ventilation tubes occurs frequently and can be missed on otoscopy. Although it is associated with poorer air conduction thresholds, the magnitude of this difference is unlikely to warrant further intervention unless there is otorrhoea or recurrence of bilateral hearing impairment.

This study aimed to compare the outcomes of ventilation tube insertion and balloon Eustachian tuboplasty as a first line treatment for otitis media with effusion in children.

This was a retrospective evaluation of 62 children, 30 cases that underwent balloon Eustachian tuboplasty (group 1) and 32 cases that underwent ventilation tube insertion (group 2), from July 2016 to April 2018.

The pre-operative air–bone gap of patients who underwent balloon Eustachian tuboplasty was 15–35 dB (mean: 27.6 ± 8.2 dB). The mean pre-operative air–bone gap decreased to 9.6 dB after a mean of 14.4 months (p < 0.05). The air–bone gap decreased from 25.6 dB to 17.6 dB in the ventilation tube group. There was a significant improvement in the air–bone gap values in both groups; however, this decrease was significantly higher in the balloon Eustachian tuboplasty group (p = 0.043).

Balloon Eustachian tuboplasty may be an effective and safe method for use as a first-line treatment of otitis media with effusion in children.

Serous otitis media is a recognised presentation of Eustachian tube dysfunction secondary to post-nasal space pathology. Post-nasal space biopsies are commonly taken in patients with isolated serous otitis media, despite normal nasendoscopy findings, without robust evidence for doing so. This study examined cases of unilateral serous otitis media with effusion in adults. It is the largest known retrospective study to investigate whether post-nasal space biopsies are indicated in non-endemic regions.

A retrospective analysis was performed of 119 patients who underwent post-nasal space biopsy because of isolated serous otitis media, in a tertiary referral centre, from 2007 to 2017. Endoscopic examination and final histological report findings were reviewed.

Of the 119 patients identified, 6 (5.0 per cent) were found to have abnormal histology. In all six cases, suspicious clinical findings had been noted on nasendoscopic examination prior to biopsy.

Suspicious findings pre-operatively predict sinister pathology. Biopsies are not recommended in cases of adult serous otitis media with normal nasendoscopy findings if no other risk factors exist. A UK-wide retrospective study or prospective study over the next 10 years will help provide the evidence necessary to support this guidance.

Balloon Eustachian tuboplasty is a surgical management option for Eustachian tube dysfunction; it has shown promising results in studies worldwide, but has had limited uptake in the UK. This study reports long-term outcomes for patients offered balloon Eustachian tuboplasty for chronic dilatory and baro-challenge-induced Eustachian tube dysfunction, and describes practical experience gained from its implementation.

Balloon Eustachian tuboplasty was conducted in 25 patients (36 ears) with Eustachian tube dysfunction over three years. Information on presenting symptoms and signs, audiometric findings, tympanometry, and Eustachian Tube Dysfunction Questionnaire-7 scores were recorded pre- and post-operatively with a minimum follow up of one year.

Sixteen (64 per cent) of the 25 patients demonstrated symptom resolution after balloon Eustachian tuboplasty according to the Eustachian Tube Dysfunction Questionnaire-7. Fourteen (64 per cent) of the 22 patients with a type B or C tympanogram pre-operatively, had a type A trace post-operatively. Fifteen (75 per cent) of 20 patients with pre-operative conductive hearing loss showed improvement post-operatively, and 11 (50 per cent) of 22 patients with pre-operative middle-ear effusion or tympanic membrane retraction showed resolution.

Balloon Eustachian tuboplasty can improve subjective and objective measures of Eustachian tube dysfunction, and provide longer-term resolution.

Animal studies have suggested that exposure of the middle ear to topical local anaesthesia may be ototoxic. This study aimed to report sensorineural hearing outcomes and patients’ satisfaction in those who underwent myringotomy and ventilation tube insertion using topical local anaesthesia.

Twenty-nine patients (32 ears) were operated on. Pre- and post-operative audiology findings were compared. A Likert-type questionnaire on treatment satisfaction was completed at the end of the procedure.

Median patient age was 55 years (range, 27–88 years). Pre- and post-operative bone conduction pure tone averages were 26.76 dB and 25.26 dB respectively (mean reduction of −1.22 dB, 95 per cent confidence interval of −5.91 to 8.13 dB; p = 0.7538). One ear (3 per cent) had a reduction in pure tone average of 10 dB.

The results suggest that sensorineural hearing loss is not a complication of ear exposure to topical local anaesthesia during myringotomy and ventilation tube insertion. The procedure was well perceived.

To determine the factors related to multiple ventilation tube insertions in children with otitis media with effusion.

A retrospective review was performed of 126 ears of 81 children aged less than 12 years who had undergone insertion of a Paparella type 1 ventilation tube for the first time between August 2012 and March 2018.

Mean age at the first operation was 4.0 ± 2.2 years, and the mean duration of otitis media with effusion before the first ventilation tube insertion was 5.4 ± 4.5 months. Among 126 ears, 80 (63.5 per cent) had a single ventilation tube insertion and 46 (36.5 per cent) had multiple insertions. On multivariate logistic regression, tympanic membrane retraction, serous middle-ear discharge, and early recurrence of otitis media with effusion were independent predictive factors of multiple ventilation tube insertions.

Tympanic membrane retraction, serous middle-ear discharge, and early recurrence of otitis media with effusion after the first tube extrusion are associated with multiple ventilation tube insertions.

Autoinflation devices are commonly used for otitis media with effusion and Eustachian tube dysfunction. Generally, these are very safe devices, with few or no complications.

This paper presents a case study of pneumocephalus and orbital emphysema, associated with the use of an autoinflation device, in a 73-year-old woman with Eustachian tube dysfunction and otitis media with effusion, and a history of extensive endoscopic sinus surgery 13 years previously.

A literature review showed autoinflation-related pneumocephalus in patients with skull base defects relating to cranial surgery or tumours; however, this has not been described previously with the Otovent system or its use in relation to functional endoscopic sinus surgery. Given the theoretical risk of undetected bony abnormalities in post-operative functional endoscopic sinus surgery patients, it is suggested that autoinflation devices are used cautiously in patients with a history of sinus surgery.

This case report illustrates an unusual case of a dural arteriovenous fistula and an associated encephalocele presenting as otitis media with effusion.

A 53-year-old man presented with right-sided hearing loss and aural fullness of 2 years’ duration. Examination revealed ipsilateral post-auricular pulsatile tenderness. Computed tomography showed transcalvarial channels suggestive of dural arteriovenous fistula. Further magnetic resonance imaging demonstrated the presence of a temporal encephalocele herniating through the tegmen tympani defect, as well as the abnormal vascularity. Angiography confirmed a Cognard type I dural arteriovenous fistula, which is being managed conservatively. Surgical repair of the encephalocele was recommended but declined by the patient.

Dural arteriovenous fistula is an uncommon intracranial vascular malformation rarely seen by otolaryngologists, with pulsatile tinnitus being the usual presentation. To our knowledge, this is the first reported case of dural arteriovenous fistula presenting with conductive hearing loss and otalgia.

Grommet insertion is a common surgical procedure in children. Long waiting times for grommet insertion are not unusual. This project aimed to streamline the process by introducing a pathway for audiologists to directly schedule children meeting National Institute for Health and Care Excellence Clinical Guideline 60 (‘CG60’) for grommet insertion.

A period from June to November 2014 was retrospectively audited. Mean duration between the first audiology appointment and grommet insertion was 294.5 days (median = 310 days). Implementing the direct-listing pathway reduced the duration between first audiology appointment and grommet insertion (mean = 232 days; median = 231 days). There has been a reduction in the time between the first audiology appointment and surgery (mean difference of 62.5 days; p = 0.024), and a reduction in the time between second audiology appointment and surgery (28 days; p = 0.009).

Direct-listing pathways for grommet insertion can reduce waiting times and expedite surgery. Implementation involves a simple alteration of current practice, adhering to National Institute for Health and Care Excellence Clinical Guideline 60. The ultimate decision regarding surgery still rests with ENT specialists.

Otitis media with effusion is a clinical manifestation characterised by inflammation of middle-ear mucosa. This study investigated the therapeutic effect of erythromycin, clarithromycin, azithromycin and roxithromycin on a histamine-induced animal model of otitis media with effusion.

The animals were divided into five groups, receiving erythromycin, clarithromycin, azithromycin, roxithromycin or saline solution. The guinea pigs in the study groups received erythromycin (40 mg/kg/day), clarithromycin (15 mg/kg/day), azithromycin (10 mg/kg/day) or roxithromycin (10 mg/kg/day) for 3 days by gastric tube. Four hours after the end of the administration, histamine solution was injected into the right middle ear.

The lowest neutrophil density value obtained using stereological techniques was in the azithromycin group (0.86 ± 0.25 × 10−5/μm3), while the highest value was observed in the control group (6.68 ± 3.12 × 10−5/μm3). The anti-inflammatory properties of clarithromycin, azithromycin and roxithromycin were similar to one another, but better than that of erythromycin.

The use of macrolide antibiotics is recommended, as they show antibacterial and anti-inflammatory efficacy in otitis media with effusion.

This study evaluated the relationship between radiation and Eustachian tube dysfunction, and examined the radiation dose required to induce otitis media with effusion.

The function of 36 Eustachian tubes in 18 patients with head and neck cancer were examined sonotubometrically before, during, and 1, 2 and 3 months after, intensity-modulated radiotherapy. Patients with an increase of 5 dB or less in sound pressure level (dB) during swallowing were categorised as being in the dysfunction group. Additionally, radiation dose distributions were assessed in all Eustachian tubes using three dose–volume histogram parameters.

Twenty-two of 25 normally functioning Eustachian tubes before radiotherapy (88.0 per cent) shifted to the dysfunction group after therapy. All ears that developed otitis media with effusion belonged to the dysfunction group. The radiation dose threshold evaluation revealed that ears with otitis media with effusion received significantly higher doses to the Eustachian tubes.

The results indicate a relationship between radiation dose and Eustachian tube dysfunction and otitis media with effusion.