系统综述：儿童咽鼓管异常开放功能障碍——耳鼻咽喉科中被低估的疾病实体。

文献信息

中文摘要

背景： 儿童咽鼓管异常开放功能障碍（PETD）在日常实践中并不常见，且常被更常见的中耳疾病所掩盖。由于儿童可能难以描述症状，且客观确认的使用并不一致，儿童期PETD的真实发生频率和临床负担仍不确定。本系统综述综合了关于儿童PETD的文献，以阐明所报告的患病率、临床表现、诊断方法、相关因素及治疗策略。
方法： 遵循系统综述和荟萃分析首选报告条目原则，对2000年至2025年7月发表的、报告儿童PETD的队列研究、临床试验和病例系列进行了综述。提取的数据包括研究设计、患者人群、患病率、就诊症状、诊断方法、相关疾病、管理和结局。方法学质量采用与研究设计相适应的评价方法进行解读。
结果： 45项研究符合纳入标准。所报告的儿童人群患病率为0.3%至1.2%，可能低估了真实负担。证据基础具有异质性，且主要由小型观察性系列组成。反复出现的主题包括被误分类为阻塞性咽鼓管功能障碍或伴渗出性中耳炎、客观检测使用不一致、缺乏儿童特异性诊断标准，以及纵向结局数据稀少。保守策略被描述得最为频繁，而儿童程序性干预的证据有限。
结论： 儿童PETD很可能被大幅低估诊断。需要提高对特征性症状的认识、建立结构化的适龄诊断路径，并标准化结局报告，以改善识别和管理。前瞻性儿童研究应验证诊断标准，并比较保守策略与介入策略。

英文摘要

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.