Eustachian tube dysfunction in obstructive sleep apnea patients: implications for a multimodal treatment approach. A systematic review

Abstract

Introduction: It is well known that Obstructive Sleep Apnea (OSA) is a complex disease characterized by an Upper Airway (UA) collapse during sleep, with potential consequences on ENT districts. Recent evidence suggests a possible association with Eustachian Tube Dysfunction (ETD). However, the potential effects of both surgical and non-surgical therapeutic strategies on ET function remain poorly explored in the current literature. This review aims to analyze the correlation between OSA and ETD, and to evaluate how invasive and non-invasive treatment OSA strategies influence ET function.

Methods: An electronic search was performed on PubMed/MEDLINE, Google Scholar, and Ovid databases using keywords as "eustachian tube," "eustachian tube dysfunction," "OSA," "obstructive sleep apnea," "pharyngeal surgery," and "CPAP." Additional cross-referencing was performed to identify relevant studies. The last search was completed in July 2024.

Results: Out of the 334 identified articles, 15 met the inclusion criteria, encompassing 125,178 patients. Studies were categorized into three groups: correlation between OSA and ETD (n = 6), effects of CPAP on ETD (n = 6), and outcomes of pharyngeal surgery on ET function (n = 3). CPAP use was associated with improved ETD symptoms and middle ear pressure. Postoperative ETD worsening was noted after pharyngeal surgery due to tissue edema and inflammation.

Conclusion: ETD appears to be a prevalent comorbidity in OSA patients. While CPAP shows a beneficial effect on ET function, surgical outcomes are less clear. Larger studies are needed to clarify these associations and guide therapeutic decisions in OSA management.

Keywords: Eustachian tube dysfunction; Middle ear pressure; Obstructive sleep apnea.