Eustachian Tube Disorders in Children.

Chronic pediatric middle ear disease is commonly ascribed to Eustachian tube dysfunction (ETD). This article reviews the role of obstructive and patulous ETD in otitis media with effusion, tympanic membrane retraction, cholesteatoma, and perforation. It highlights the lack of reliable diagnostic tests to measure ETD. The contribution of different causes of obstructive ETD is discussed, including the influence of mechanical obstruction, inflammation, allergy, mucociliary dysfunction, and craniofacial anomalies. ETD management has traditionally bypassed the Eustachian tube, for example, with tympanostomy tubes. Balloon dilatation remains controversial in children due to unproven efficacy and safety and the heterogeneous underlying mechanisms of ETD.