Pediatric Balloon Eustachian Tuboplasty: A Systematic Review and Meta-analysis of Short and Long-term Outcomes

Introduction: Eustachian tube dysfunction (ETD) commonly contributes to chronic middle ear disease in children, yet standard approaches such as tympanostomy tubes and adenoidectomy fail to address its underlying causes. While balloon eustachian tuboplasty (BET) has emerged as a viable therapy in adults, current pediatric data are limited and underpowered, and the durability of its effects has not yet been evaluated in a systematic manner.

Methods: PubMed-NCBI, Embase, Web of Science, CINAHL, and the Cochrane Library were searched for studies published before August 1st, 2025 assessing the efficacy of BET in pediatric patients. Studies were included if < 25% of ears had tubes or perforations to minimize confounding; in multi-arm studies, only the BET-only arms were extracted. Changes from baseline tympanogram type and Valsalva ability were analyzed using random-effects meta-analysis.

Results: Of the 70 studies considered for full-text review, 9 comprising 479 children (881 ears) were eligible for the systematic review. Among studies reporting short-term outcomes, the proportion of patients able to equalize pressure improved by 44% (95% CI 0.19-0.69) at short-term ( < 4 months) follow-up; long-term follow-up (9-14 months) showed sustained improvement, reported in a separate subset of studies. Tympanogram normalization increased by 52% (95% CI 0.31–0.73) at short-term and 57% long-term (95% CI 0.21-0.92). Of the two studies reporting otoscopy, both showed significant improvement at 12 months. Heterogeneity and overall risk of bias among studies was high.

Conclusions: BET appears to confer sustained, long-term improvement in middle ear function in children with ETD. Larger, high-quality randomized controlled trials are warranted to confirm and expand on these findings relative to the standard surgical approaches.