Impact of endoscopic sinus surgery on Eustachian tube dysfunction in patients with chronic rhinosinusitis: systematic review and meta-analysis

Background: Eustachian tube dysfunction (ETD) has been associated with inflammatory conditions (1). Many studies have identified a high prevalence of ETD in patients with chronic rhinosinusitis (CRS) (2). However, there is a paucity of higher-level evidence assessing the impact of endoscopic sinus surgery (ESS) on patients with ETD concurrent disease. Methods: Systematic review and meta-analysis of non-randomised studies on the impact of ESS on ETD in patients with CRS, based on the eustachian tube dysfunction questionnaire (ETDQ-7) scores. PRISMA guidelines were followed according to a priori study protocol (PROSPERO Registration number: CRD42021245677). A random-effects model was employed. Results: 21 results were obtained using our search strategy. Four studies met our inclusion criteria. 501 patients were identified in the included studies. The prevalence of ETD in CRS patients in our review was 55.1%. Pooled estimates showed a statistically significant reduction in ETDQ-7 scores. Conclusions: The evidence to date suggests there is a high prevalence of concurrent ETD in CRS patients, the symptoms of which improved following ESS for CRS in this patient group. However, the current evidence base is comprised of uncontrolled case series. High-quality, randomised controlled studies with long-term follow-up are lacking.