Autoinflation as a Eustachian Tube Rehabilitation

Otitis media with effusion (OME) is a prevalent pediatric condition that may lead to hearing loss and developmental delay. Tympanostomy tube (TT) placement is the standard treatment for persistent OME but does not address the underlying cause, and recurrence is common after TT extrusion. This study investigated whether autoinflation after TT extrusion could reduce OME recurrence and the need for reoperation.

In this prospective randomized controlled trial, 66 children aged 3 to 8 years with chronic OME were enrolled at a tertiary hospital. All underwent TT placement under general anesthesia and were followed bi-monthly in the outpatient clinic. After TT extrusion, 54 patients were randomized to either the autoinflation group (n = 26) or the observation group (n = 28). The autoinflation group used the Eustachi device twice daily for five weeks, with instructions provided to children and caregivers. Patients with adenoid hypertrophy, craniofacial anomalies, active otologic disease, or severe systemic disease were excluded.

Outcome measures included OME recurrence and TT reoperation rates over two years, evaluated through otoscopy and tympanometry. The recurrence rate was lower in the autoinflation group (19.2%) than in the observation group (35.7%), though the difference was not statistically significant. However, the reoperation rate was significantly lower in the autoinflation group (7.7%) compared to the observation group (28.6%, p = 0.048). Tympanometry results also showed stable middle ear pressure in the autoinflation group, whereas the observation group experienced a decline in type A tympanograms and an increase in type C patterns over time.

These findings suggest that autoinflation may promote functional rehabilitation of the eustachian tube and maintain middle ear ventilation after TT extrusion. The intervention was well tolerated and feasible in a home setting with caregiver supervision. While autoinflation should not replace TT placement in persistent OME, it may serve as a valuable non-invasive strategy to reduce the risk of recurrence and the need for repeat surgery. Limitations include sample size and lack of quantitative compliance data, warranting future multicenter studies for validation.

Inclusion criteria

• Children aged 3 to 8 years
• Clinical diagnosis of chronic otitis media with effusion (OME)
• Underwent tympanostomy tube (TT) placement for persistent OME lasting more than 3 months
• Capable of performing autoinflation, as assessed by the physician
• Caregiver willing to provide informed consent and assist with at-home device use

Exclusion criteria

• Presence of adenoid hypertrophy or tonsillar hypertrophy
• History of craniofacial anomalies (e.g., cleft palate)
• Current otologic disease such as otorrhea or tympanic membrane perforation
• Acute otitis media or signs of active inflammation at enrollment
• Underlying severe systemic disease or immunodeficiency
• Inability or refusal to follow autoinflation protocol