The global burden of eustachian tube dysfunction in older patients: pathophysiology, clinical consequences, diagnostic challenges and therapeutic perspectives-a SANRA-based study

Objective: To critically summarize current evidence regarding the burden of Eustachian tube dysfunction (ETD) in older adults, focusing on age-related pathophysiology, diagnostic challenges, therapeutic strategies and its interaction with major geriatric clinical implications. Methods: This narrative review was conducted according to the Scale for the Assessment of Narrative Review Articles (SANRA). PubMed-indexed original studies, systematic reviews, meta-analyses, consensus statements and clinical guidelines addressing ETD and ageing were systematically identified and critically appraised. Evidence was synthesized narratively with particular emphasis on studies applicable to geriatric populations. Results: Current evidence demonstrates that ageing induces progressive structural and functional alterations throughout the Eustachian tube-middle ear unit, including cartilage calcification, muscular degeneration, mucosal atrophy and impaired neuromuscular coordination. These changes may increase susceptibility to ETD, which in turn can exacerbate presbycusis, vestibular dysfunction, communication disability and potentially contribute to frailty and cognitive vulnerability by increasing the cumulative burden of sensory impairment. However, evidence specifically derived from geriatric cohorts remains limited, particularly regarding long-term outcomes and therapeutic interventions and is insufficient to establish ETD as an independent determinant of these conditions. Conclusions: ETD should be recognized as an underdiagnosed and potentially modifiable contributor to hearing-related disability in older adults. Greater clinical awareness, standardized diagnostic pathways and prospective geriatric-focused studies are needed to clarify whether timely diagnosis and treatment of ETD can reduce the overall burden of hearing impairment, improve functional independence and enhance quality of life in ageing populations.