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. 2017 Dec;37(6):509–512. doi: 10.14639/0392-100X-1690

Fig. 1.

Parent questionnaire.

  1. When was balloon dilation performed?

  2. How many middle ear infections has your child had since balloon dilation of the Eustachian tube was performed?

  3. How many times has your child required antibiotic treatment?

  4. How many times has your child had otitis media with effusion?

  5. How many times has your child undergone myringotomy or tympanostomy tube placement since balloon dilation of the Eustachian tube was performed?

  6. Has your child's hearing improved after balloon dilation?

  7. Has your child had any problems after balloon dilation?

     Yes/no

    If yes, what problems?

     Severe – moderate – mild

  8. How satisfied are you with the treatment result?

     Very satisfied – satisfied – fairly satisfied – not satisfied