A Systematic Review of Eustachian Tube Dysfunction in Patients Undergoing Septoplasty: Pre-operative Prevalence and Post-operative Outcomes.

INTRODUCTION: The relationship between septoplasty and Eustachian Tube Dysfunction (ETD) remains controversial despite theoretical links between nasal anatomy and middle ear physiology. MATERIALS AND METHODS: Following PRISMA guidelines, we searched PubMed, Scopus, Web of Science, CENTRAL, and Embase up to October 2025 for studies examining ETD in septoplasty candidates. Twenty-eight studies (20 prospective cohorts, 5 retrospective cohorts, 3 RCTs; N≈2,150) met inclusion criteria. RESULTS: Pre-operative ETD prevalence was high: 38-62% by ETDQ-7 questionnaire and 35-65% by tympanometry. Septoplasty significantly improved both subjective symptoms and objective middle ear function, with peak benefits at 3-6 months. Aural fullness showed the most notable improvement. Greater pre-operative ETD severity and posterior septal deviation were associated with more substantial improvement. Transient post-operative worsening occurred in some patients but resolved spontaneously. CONCLUSIONS: ETD is a frequent comorbidity in symptomatic deviated nasal septum patients. Septoplasty appears effective for concomitant ETD, supporting routine pre-operative ETD assessment and patient counseling about potential otological benefits. Evidence is moderate-level due to observational study dominance and heterogeneity.