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Meta-Analysis
. 2025 Feb 26;2(2):CD013429.
doi: 10.1002/14651858.CD013429.pub2.

Balloon dilatation of the Eustachian tube for obstructive Eustachian tube dysfunction in adults

Chloe Swords  1   2 , Matthew E Smith  1   2 , Anant Patel  3 , Gill Norman  4   5 , Alexis Llewellyn  6 , James R Tysome  1   2
Affiliations
Meta-Analysis

Balloon dilatation of the Eustachian tube for obstructive Eustachian tube dysfunction in adults

Chloe Swords et al. Cochrane Database Syst Rev. .

Abstract

Background: Eustachian tube dysfunction (ETD) causes symptoms and signs of pressure dysregulation in the middle ear, and is associated with tympanic membrane retraction, otitis media with effusion, and chronic otitis media. Interventions aiming to improve symptoms can be non-surgical or surgical, including balloon dilatation of the Eustachian tube, also known as balloon eustachian tuboplasty (BET) for obstructive ETD. However, existing published evidence for the effectiveness and safety of BET remains unclear.

Objectives: To evaluate the effects of balloon dilatation of the Eustachian tube in adults with obstructive Eustachian tube dysfunction.

Search methods: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid M>DLINE; Ovid Embase; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The final search was updated on 18th January 2024. There were no restrictions on language, publication date or study setting.

Selection criteria: Randomised controlled trials were included if they allocated adult participants with chronic obstructive ETD to treatment randomly and compared BET with non-surgical treatment, no treatment, or other surgical treatment. Studies with other designs were excluded.

Data collection and analysis: At least two review authors independently selected trials using predetermined inclusion criteria, assessed the risk of bias, extracted data, and rated the certainty of evidence (CoE) according to GRADEpro. Statistical analyses were performed using a random-effects model and interpreted according to the most recent version of the Cochrane Handbook. Predefined primary outcomes were obstructive ETD symptoms, Eustachian tube function (objective or semi-objective tests), or serious adverse events. Secondary outcomes were hearing, tympanic membrane abnormalities, quality of life, and other adverse events.

Main results: Nine trials were identified with 684 randomised participants across three comparisons: BET versus non-surgical treatment (five trials, 422 participants), BET versus no treatment (sham surgery; one trial, 17 participants), and BET versus other surgery (four trials, 275 participants). None of the studies were rated with an overall low risk of bias. Comparing BET to non-surgical treatment up to three months, there is low-certainty evidence showing that BET may reduce patient-reported ETD symptoms (change in ETDQ-7: mean difference (MD) -1.66 (95% CI -2.16 to -1.16; I2 = 63%; 4 RCTs, 362 participants)). There is very low-certainty evidence that BET may improve ETD as assessed by objective or semi-objective measures (improvement in tympanometry: RR 2.51 (95% CI 1.82 to 3.48; I2 = 0%; 3 RCTs, 369 participants). Between three and 12 months, the evidence is very uncertain whether BET reduces ETDQ-7: MD -0.55 (-1.31 to 0.21; 1 RCT, 24 participants). The evidence is very uncertain whether BET improves ETD as assessed by objective or semi-objective measures (improvement in tympanometry: RR 2.54 (95% CI 0.91 to 7.12)). Evidence was downgraded for risk of bias, imprecision, indirectness, or a combination of these. Comparing BET to no treatment (sham surgery trial) up to three months, there is very low-certainty evidence that BET improves ETD as assessed by patient-reported ETD symptoms (change in ETDQ-7: MD -0.54 (95% CI -2.55 to 1.47; 1 RCT, 17 participants)). Between three and 12 months, the evidence is very uncertain whether BET improves ETD as assessed by ETDQ-7 (MD 0.16 (95% CI -0.75 to 1.07; 1 RCT, 17 participants)). Evidence was downgraded for indirectness and twice for imprecision. Although there were no serious adverse events reported, these studies were underpowered to detect adverse events and were performed by highly trained and experienced investigators under strict study protocols. This could underestimate the true risk of adverse events by less experienced clinicians in everyday clinical practice. Evidence was rated as very low certainty, downgraded for risk of bias, imprecision, and indirectness.

Authors' conclusions: BET may lead to a clinically meaningful improvement in ETD symptoms compared to non-surgical or no treatment (in the form of sham surgery) at up to three months. The effects of BET on ETD compared to non-surgical treatment are very uncertain beyond three months. However, the certainty of evidence ranged from low to very low, with the studies being underpowered to detect adverse events. The findings of this review should help to inform further BET research and guidelines. Future research should focus on longer-term outcomes and the incidence of adverse events or complications in real-world practice settings.

Trial registration: ClinicalTrials.gov ACTRN12618001681246 IRCT2015091524031N1 ISRCTN02147658 NCT02123277 NCT02087150 NCT02114762 NCT02391584 NCT02631187 NCT03322579 NCT03440710 NCT03886740 NCT04055714 NCT04136977 NCT05270031 ISRCTN38272958 KCT0005817 NCT03556215.

PubMed Disclaimer

Conflict of interest statement

Chloe Swords: none known.

Matthew E Smith: Matthew Smith was trained in the BET technique in Bielefeld, Germany, with expenses covered by Spiggle and Theis GmbH (October 2014). A UK registry of BET procedures run by Matthew Smith is part funded by Stryker Corp. and Minim Healthcare Ltd.

Anant Patel: none known.

Gill Norman: Gill Norman was the Editor of Cochrane Wounds until March 2023. She was not involved in the editorial process for this current review. She attended a diagnostic consensus meeting funded by Acclarent (a BET device manufacturer & Johnson and Johnson subsidiary) in June 2014, but she received no financial compensation and expenses were met by the University of York.

Alexis Llewellyn: none known.

James R Tysome: James Tysome has received a research grant from Spiggle and Theis GmbH, an instrument manufacturing company who markets a BET device (2015). The grant was not provided for this review and the company had no influence on its creation. He also received an honorarium for a lecture in 2019 at Minim Healthcare. He is the editor‐in‐chief of Clinical Otolaryngology and is affiliated with the NICE Interventional Advisory Committee.

Update of

References

References to studies included in this review

Abdel Aziz 2022 {published data only}
    1. Aziz A, Youssef AM, Mostafa MM, Talaat M, Abdelzaher KA, Sadeq AA. Cartilage tympanoplasty in the treatment of adhesive otitis media with and without Eustachian tube balloon dilatation. Journal of Otology 2022;17(4):226-31. [PMID: ] - PMC - PubMed
Alahmer 2021 {published data only}
    1. Alahmer MH, Wahba AA. Combined endoscopic sinus surgery and Eustachian tube balloon dilatation improves Eustachian tube functions in patients had chronic rhinosinusitis with nasal polyposis and Eustachian tube dysfunction. International Journal of Medical Arts 2021;3(1):1125-35. [PMID: ]
Choi 2021 {published data only}
    1. Choi S-W, Oh S-J, Kim Y, Kwak MY, Suh M-W, Park MK, et al. A multicenter, randomized, active-controlled, clinical trial study to evaluate the efficacy and safety of navigation guided balloon Eustachian tuboplasty. Scientific Reports 2021;11(1):23296. [PMID: ] - PMC - PubMed
Krogshede 2022 {published and unpublished data}
    1. Krogshede SK, Kirchmann M, Jorkov AP, Glad H. Balloon dilation of the eustachian tube: a randomized controlled trial with 6 months follow-up. Journal of International Advanced Otology 2022;18(6):501-6. [PMID: ] - PMC - PubMed
Laakso 2023 {published data only}
    1. Laakso JT, Oehlandt H, Kivekas I, HarjuT, Jero J, Sinkkonen ST. Balloon eustachian tuboplasty - a feasible double-blinded sham surgery randomized clinical trial protocol to study efficacy. Laryngoscope 2023;134(4):Online ahead of print. [DOI: 10.1002/lary.31092] - DOI - PubMed
Liang 2016 {published data only}
    1. Liang M, Xiong H, Cai Y, Chen Y, Zhang Z, Chen S, et al. Effect of the combination of balloon eustachian tuboplasty and tympanic paracentesis on intractable chronic otitis media with effusion. American Journal of Otolaryngology 2016;37(5):442-6. [PMID: ] - PubMed
Meyer 2018 {published data only (unpublished sought but not used)}
    1. Meyer TA, O'Malley EM, Schlosser RJ, Soler ZM, Cai J, Hoy MJ, et al. A randomized controlled trial of balloon dilation as a treatment for persistent eustachian tube dysfunction with 1-year follow-up. Otology & Neurotology 2018;39(7):894-902. [PMID: ] - PMC - PubMed
Poe 2017 {published data only}
    1. Anand V, Poe D, Dean M, Roberts W, Stolovitzky P, Hoffmann K, et al. Balloon dilation of the eustachian tube: 12-month follow-up of the randomized controlled trial treatment group. Otolaryngology - Head and Neck Surgery 2019;160(4):687-94. [DOI: 10.1177/0194599818821938] - DOI - PubMed
    1. Poe D, Anand V, Dean M, Roberts WH, Stolovitzky JP, Hoffmann K, et al. Balloon dilation of the eustachian tube for dilatory dysfunction: a randomized controlled trial. Laryngoscope 2018;128(5):1200-6. [PMID: ] - PubMed
Si 2019 {published data only}
    1. Si Y, Chen Y, Xu G, Chen X, He W, Zhang Z. Cartilage tympanoplasty combined with eustachian tube balloon dilatation in the treatment of adhesive otitis media. Laryngoscope 2019;129(6):1462-7. [PMID: ] - PubMed

References to studies excluded from this review

ACTRN12618001681246 {published data only}
    1. ACTRN12618001681246. Balloon dilatation for eustachian tube obstruction: a randomised control trial. https://dev.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375846 (date registered 11/10/2018). [URL: https://dev.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375846]
Anand 2017 {published data only}
    1. Anand V, Leopold J, Poe D. Balloon dilation of the eustachian tube: 12 months follow-up. Otolaryngology - Head and Neck Surgery 2017;157(1 Suppl 1):P53-P54. [DOI: 10.1177/0194599817717251] - DOI - PubMed
ChiCTR1800015587 {published data only}ChiCTR1800015587
    1. ChiCTR1800015587. Effect of Eustachian tube balloon on the treatment of chronic suppurative otitis media. https://www.chictr.org.cn/showprojEN.html?proj=24411 (date of registration 2018-04-10). [URL: https://www.chictr.org.cn/showprojEN.html?proj=24411]
Cutler 2019 {published data only}
    1. Cutler JL, Meyer TA, Nguyen SA, O'Malley EM, Thackeray L, Slater PW. Long-term outcomes of balloon dilation for persistent eustachian tube dysfunction. Otology & Neurotology 2019;40(10):1322-5. [DOI: 10.1097/MAO.0000000000002396] - DOI - PubMed
Dalchow 2011 {published data only}
    1. Dalchow C, Muenscher A, Knecht R. Endoscopic dilatation of the eustachian tube. Otolaryngology - Head and Neck Surgery 2011;145:93. [DOI: 10.1177/0194599811416318a1] - DOI
Eroglu 2022 {published data only}
    1. Eroglu E, Bajin MD. Comparative results of eustachian balloon dilatation and nasal steroid therapy in the eustachian tube dysfunction. European Journal of Rhinology and Allergy 2022;5:12-9. [DOI: 10.5152/ejra.2022.21055] - DOI
Formankova‐a 2019 {published data only}https://www.prolekare.cz/casopisy/otorinolaryngologie-foniatrie/2019-4-17/terapie-chronickeho-sekretorickeho-stredousniho-zanetu-balonkovou-dilataci-eustachovy-tuby-119901
    1. Formankova D, Formanek M, Zelenik K, Kominek P. Terapie chronickeho sekretorickeho stredousniho zanetu balonkovou dilataci Eustachovy tuby. Otorhinolaryngology & Phoniatrics/Otorinolaryngologie a Foniatrie 2019;68(4):e. [URL: https://www.prolekare.cz/casopisy/otorinolaryngologie-foniatrie/2019-4-1...]
Formankova‐b 2019 {published data only}
    1. Formankova D, Formanek M, Skoloudik L, Zelenik K, Tomaskova H, Chrobok V, et al. Balloon eustachian tuboplasty combined with tympanocentesis is not superior to balloon eustachian tuboplasty in chronic otitis media with effusion - a randomized clinical trial. Otology & Neurotology 2020;41(3):339-44. [DOI: 10.1097/MAO.0000000000002518] - DOI - PubMed
Froehlich 2019 {published data only}
    1. Froehlich MH, Le PT, Nguyen SA, Rizk H, McRackan T, Meyer TA. Eustachian tube balloon dilation: a systematic review and meta-analysis. Otolaryngology - Head and Neck Surgery 2019;163(5):870-82. [DOI: 10.1177/0194599820924322] - DOI - PubMed
Holm Niels 2019 {published data only}https://content.ugeskriftet.dk/sites/default/files/scientific_article_files/2019-01/v03180209_0.pdf
    1. Højvang HN, Nue MM, Leganger LP, Højberg WJ, Henrik G, Michael G, et al. Workup and treatment of Eustachian tube dysfunction in adults [Udredning og behandling af dysfungerende eustakisk rør hos voksne]. Ugeskrift for Laeger 2019;181(3):V03180209. [URL: https://content.ugeskriftet.dk/sites/default/files/scientific_article_fi...] - PubMed
Huisman 2018 {published data only}
    1. Huisman JM, Verdam FJ, Stegeman I, De Ru JA. Treatment of Eustachian tube dysfunction with balloon dilation: a systematic review. Laryngoscope 2018;128(1):237-47. [DOI: 10.1002/lary.26800] - DOI - PubMed
IRCT2015091524031N1 {published data only}
    1. IRCT2015091524031N1. Evaluation result of balloon tuboplasty on patients with serous otitis media. https://irct.behdasht.gov.ir/trial/20378 (first registered 2015-12-27). [URL: https://irct.behdasht.gov.ir/trial/20378]
ISRCTN02147658 {published data only}
    1. ISRCTN02147658. Effect of balloon dilatation on Eustachian tube dysfunction: a randomised controlled study. https://trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN02147658 (date of registration:28/12/2011). [URL: https://trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN02147658]
Kaderbay 2014 {published data only}
    1. Kaderbay A, Karkas A, Schmitt D, Mura T, Lavieille JP, Venail F. Long term evaluation of tubal expansion on obstructive dysfunctions of eustachian tube. European Archives of Otorhinolaryngology 2014;280(3):1101-9. [DOI: 10.1007/s00405-022-07578-2] - DOI - PubMed
KCT0005627 {published data only}
    1. KCT0005627. A multicenter clinical trial study to evaluate the efficacy and safety of navigation guided balloon Eustachian tuboplasty for patients with Eustachian tube dysfunction. https://trialsearch.who.int/Trial2.aspx?TrialID=KCT0005627 (Date of registration: 2020-11-24). [URL: https://trialsearch.who.int/Trial2.aspx?TrialID=KCT0005627]
Llewellyn 2014 {published data only}
    1. Llewellyn A, Norman G, Harden M, Coatesworth A, Kimberling D, Schilder A, et al. Interventions for adult Eustachian tube dysfunction: a systematic review. Health Technology Assessment (Winchester, England) 2014;18(46):1-180, v-vi. [DOI: 10.3310/hta18460] - DOI - PMC - PubMed
Lu 2022 {published data only}
    1. Lu S, Xu J, Lu H, Chi W. Balloon eustachian tuboplasty and grommet insertion: a combined surgical treatment for chronic suppurative otitis media with eustachian tube dysfunction. Evidence-Based Complementary and Alternative Medicine 2022;9516029:9516029. [DOI: 10.1155/2022/9516029] - DOI - PMC - PubMed
Luukkainen 2018 {published data only}
    1. Luukkainen V, Kivekas I, Silvola J, Jero J, Sinkkonen ST. Balloon eustachian tuboplasty: systematic review of long-term outcomes and proposed indications. Journal of International Advanced Otology 2018;14(1):112-26. [DOI: 10.5152/iao.2018.4769] - DOI - PMC - PubMed
NCT02087150 {published data only}
    1. NCT02087150. Study of safety and efficacy for the eustachian tube balloon catheter. https://clinicaltrials.gov/study/NCT02087150 (first posted 2014-03-14).
NCT02114762 {published data only}
    1. NCT02114762. Balloon dilation in selected subjects with refractory eustachian tube dysfunction. Https://clinicaltrials.gov/show/NCT02114762 (first posted 2014-04-15). [URL: https://clinicaltrials.gov/study/NCT02114762]
NCT02391584 {published data only}
    1. NCT02391584. Xpress eustachian tube dilation study. Https://clinicaltrials.gov/show/NCT02391584 (first posted 2015-03-18).
NCT02631187 {published data only}
    1. NCT02631187. Feasibility study of balloon eustachian tuboplasty (BET). https://classic.clinicaltrials.gov/ct2/show/NCT02631187 (first posted 2015-12-16). [URL: https://classic.clinicaltrials.gov/ct2/show/NCT02631187]
NCT03322579 {published data only}
    1. NCT03322579. Balloon dilation of the eustachian tube, a lower pressure challenge. Https://clinicaltrials.gov/show/NCT03322579 (first posted 2017-10-26). [URL: Https://clinicaltrials.gov/show/nct03322579]
NCT03440710 {published data only}
    1. NCT03440710. The therapeutic effect of BET in COM with ETD. https://classic.clinicaltrials.gov/ct2/history/NCT03440710?V_1=View (Record Verification 2018-02). [URL: https://classic.clinicaltrials.gov/ct2/history/NCT03440710?V_1=View]
NCT03886740 {published data only}
    1. NCT03886740. Tympanostomy tubes versus eustachian tube dilation. https://clinicaltrials.gov/study/NCT03886740?term=NCT03886740&rank=1 (first posted 2019-03-22).
NCT04055714 {published data only}
    1. NCT04055714. Feasibility of balloon dilation of the eustachian tubes under local anesthesia. https://clinicaltrials.gov/show/NCT04055714 (first posted 2019-08-14). [URL: Https://clinicaltrials.gov/show/NCT04055714]
NCT04136977 {published data only}
    1. NCT04136977. XprESS ET Registry. https://clinicaltrials.gov/study/NCT04136977?id=NCT04136977%20&rank=1 (first posted 2019-10-23). [URL: https://clinicaltrials.gov/study/NCT04136977?id=NCT04136977%20&rank=1]
NCT05270031 {published data only}
    1. NCT05270031. Balloon dilation of the eustachian tube (BDET). https://clinicaltrials.gov/show/NCT05270031 (first posted 2022-03-08). [URL: https://clinicaltrials.gov/show/NCT05270031]
Norman 2014 {published data only}
    1. Norman G, Llewellyn A, Harden M, Coatesworth A, Kimberling D, Schilder A, et al. Systematic review of the limited evidence base for treatments of Eustachian tube dysfunction: a health technology assessment. Clinical Otolaryngology 2014;39(1):6-21. [DOI: 10.1111/coa.12220] - DOI - PubMed
Plaza 2019 {published data only}
    1. Plaza G, Navarro JJ, Alfaro J, Sandoval M, Marco J. Consensus on treatment of obstructive Eustachian tube dysfunction with balloon Eustachian tuboplasty. Acta Otorrinolaringologica Espanola 2019;71(3):181-9. [DOI: 10.1016/j.otorri.2019.01.005] - DOI - PubMed
Randrup 2015 {published data only}
    1. Randrup TS, Ovesen T. Balloon eustachian tuboplasty: a systematic review. Otolaryngology - Head & Neck Surgery 2015;152(3):383-92. [DOI: 10.1177/0194599814567105] - DOI - PubMed
Silvola 2014 {published data only}
    1. Silvola J, Kivekas I, Poe DS. Balloon dilation of the cartilaginous portion of the Eustachian tube. Otolaryngology - Head and Neck Surgery 2014;151(1):125-30. [DOI: 10.1177/0194599814529538] - DOI - PubMed
Siow 2020 {published data only}
    1. Siow JK, Tan JL. Indications for Eustachian tube dilation. Current Opinion in Otolaryngology & Head and Neck Surgery 2020;28(1):31-5. [DOI: 10.1097/MOO.0000000000000601] - DOI - PubMed
Tisch 2013 {published data only}
    1. Tisch M, Maier S, Maier H. Eustachian tube dilation using the Bielefeld balloon catheter: clinical experience with 320 interventions. Deutsche Gesellschaft der Hals Nasen und Ohrenarzte 2013;61(6):483-7. [DOI: 10.1007/s00106-013-2711-6] - DOI - PubMed
Van Roeyen 2017 {published data only}
    1. Van Roeyen S, Van de Heyning P, Van Rompaey V. Delayed-start study design for balloon dilation of the eustachian tube: alternative for a randomized controlled trial. Frontiers in Surgery 2017;4:10. [DOI: 10.3389/fsurg.2017.00010] - DOI - PMC - PubMed
Wang 2018 {published data only}
    1. Wang TC, Lin CD, Shih TC, Chung HK, Wang CY, Tsou YA, et al. Comparison of balloon dilation and laser eustachian tuboplasty in patients with eustachian tube dysfunction: a meta-analysis. Otolaryngology - Head and Neck Surgery 2018;158(4):617-26. [DOI: 10.1177/0194599817753609] - DOI - PubMed
Zhang 2021 {published data only (unpublished sought but not used)}
    1. Zhang H, Yu F, Wu Y. Analysis of treatment approaches for chronic suppurative otitis media with eustachian tube dysfunction. Journal of Otolaryngology and Ophthalmology Shandong University 2019;33:72-5. [DOI: 10.6040/j.issn.1673-3770.0.2018.094] - DOI
Zirkler 2016 {published data only}
    1. Zirkler J, Rahne T, Lautenschlager C, Honigmann R, Plontke SK. Balloon dilatation of the Eustachian tube during middle ear surgery: study planning and first experiences during recruitment. Deutsche Gesellschaft der Hals Nasen und Ohrenarzte 2016;64(4):237-42. [DOI: 10.1007/s00106-016-0146-6] - DOI - PubMed

References to ongoing studies

DRKS00011088 {published data only}https://drks.de/search/de/trial/DRKS00011088
    1. DRKS00011088. Comparative study of the therapeutic success of tubal dilatation and paracentesis versus paracentesis and tympanic drainage for persistent or recurrent tympanic effusion in adults. https://drks.de/search/de/trial/DRKS00011088 (Registration date in DRKS: September 13, 2016). [TRIAL DATABASE: https://drks.de/search/de/trial/DRKS00011088]
ISRCTN38272958 {published data only}
    1. ISRCTN38272958. Role of Eustachian tube surgery in the treatment of chronic secretory otitis media. https://trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN38272958 (Date of registration 08/07/2021). [URL: https://trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN38272958]
KCT0005817 {published data only (unpublished sought but not used)}
    1. KCT0005817. A prospective multicenter randomized controlled study for the evaluation of efficacy and safety of balloon eustachian tuboplasty for patients with chronic otitis media due to obstructive tube dysfunction. https://trialsearch.who.int/Trial2.aspx?TrialID=KCT0005817 (Date of registration: 2021-01-25). [URL: https://trialsearch.who.int/Trial2.aspx?TrialID=KCT0005817]
Li 2020 {published data only (unpublished sought but not used)}
    1. Li H, Zhou Y, Huang J, Zhang L, Lou Z. Treatment of secretory otitis media with balloon dilation and tympanostomy tube insertion: a randomized controlled trial. Basic & Clinical Pharmacology & Toxicology 2020;127(S1):3-293. [DOI: 10.1111/bcpt.13461] - DOI
NCT03556215 {published data only}
    1. NCT03556215. Balloon eustachian tuboplasty in treatment of chronic eustachian tube dysfunction. Https://clinicaltrials.gov/show/NCT03556215 (first posted 2018-06-14). [URL: Https://clinicaltrials.gov/show/NCT03556215]
Teng 2021 {published data only (unpublished sought but not used)}https://regroup-production.s3.amazonaws.com/documents/ReviewReference/431688346/Teng_2021_BET%20RCT%20pilot.pdf?response-content-type=application%2Fpdf&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=AKIAYSFKCAWYQ4D5IUHG%2F20231216%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20231216T145003Z&X-Amz-Expires=604800&X-Amz-SignedHeaders=host&X-Amz-Signature=eeff6af32bfadf1e3c9d2ba059d4d15411f5a938b3a62051ab454f5181f6d436
    1. Teng TS, Hashim ND, Abdullah A. The eustachian tube balloon dilatation versus conventional medical treatment in treating eustachian tube dysfunction: a pilot study. Medical Journal of Malaysia 2021;76(Suppl 1):18 OP 14. [URL: https://www.e-mjm.org/2021/v76s1/OP-13-14.pdf]

Additional references

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