Holger SUDHOFF
The Journal of International Advanced Otology - 2026;22(3):1-6
BACKGROUND: Pediatric patulous Eustachian tube dysfunction (PETD) is uncommon in daily practice and is often overshadowed by more prevalent middle ear disorders. Because symptoms may be difficult for children to describe and objective confirmation is inconsistently used, the true frequency and clinical burden of PETD in childhood remain uncertain. This systematic review synthesized the literature on pediatric PETD to clarify reported prevalence, clinical presentation, diagnostic approaches, associated factors, and treatment strategies. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles, cohort studies, clinical trials, and case series published from 2000 to July 2025 that reported pediatric PETD were reviewed. Data were extracted on study design, patient population, prevalence, presenting symptoms, diagnostic methods, associated conditions, management, and outcomes. Methodological quality was interpreted using study-design-appropriate appraisal approaches. RESULTS: Forty-five studies met the inclusion criteria. Reported prevalence in pediatric populations ranged from 0.3% to 1.2%, likely underestimating the true burden. The evidence base was heterogeneous and largely composed of small observational series. Recurrent themes included misclassification as obstructive Eustachian tube dysfunction or otitis media with effusion, inconsistent use of objective testing, limited pediatric-specific diagnostic criteria, and sparse longitudinal outcome data. Conservative strategies were most frequently described, whereas evidence for procedural intervention in children was limited. CONCLUSION: Pediatric PETD is likely substantially underdiagnosed. Greater awareness of characteristic symptoms, structured age-appropriate diagnostic pathways, and standardized outcome reporting are needed to improve recognition and management. Prospective pediatric studies should validate diagnostic criteria and compare conservative and interventional strategies.
