Laser vs microdebrider eustachian tuboplasty for the treatment of chronic adult eustachian tube dysfunction: A systematic review

ObjectivesMultiple treatments are described in the literature for the treatment of chronic Eustachian tube dysfunction but high-level quality evidence seems missing to support these treatments. This systematic review aimed to determine and compare the safety and efficacy of Laser Eustachian tuboplasty and Microdebrider Eustachian tuboplasty as a treatment for long-term Eustachian tube dysfunction.Data sourcesA total of 12 electronic databases were searched up to April 2018 for published and unpublished literature in the English language. References of included studies were checked.MethodsA systematic review was undertaken. Outcomes assessed were: primary outcomes-subjective improvement in symptoms (ETDQ-7), audiometric improvement of hearing, improvement of negative middle ear pressure noticed in tympanometry, objective improvement of tympanic membrane retraction. Secondary outcomes were-the ability to auto-insufflate Eustachian tube i.e. Valsalva manoeuvre, improved quality of life, passive tubal opening, tubomanometry, swallowing test, reduction in mucosal inflammation of Eustachian tube orifice in the nose, complications from the procedure, the need for further procedures. Results are reported in a narrative synthesis as a meta-analysis was not possible due to heterogeneous data.ResultsThree studies were included. All included studies were small-scale case series (13–38 participants). Studies were conducted outside the UK. Subjective and objective improvement of Eustachian tube function was reported in all studies. But all included studies were at high risk of bias and subject to multiple limitations. No major complications were reported in either study.ConclusionsBased on current evidence, it is not possible to recommend the clinical use of either of these two interventions i.e. Laser or Microdebrider Eustachian tuboplasty. Lack of controlled studies was identified as a gap in the evidence. Future research should be directed toward designing randomised controlled trials. These trials should use strict standard methodology and reporting criteria. Future trials should make use of consensus statement document about Eustachian tube dysfunction definition, diagnostic methods, and outcome assessment criteria to design clinical trials.     

Direct application of dexamethasone for the treatment of chronic eustachian tube dysfunction

We undertook a prospective study to determine the safety and effectiveness of the direct administration of a steroid to the eustachian tube via the Silverstein MicroWick in 11 patients with chronic eustachian tube dysfunction, including two who had Samter's triad. All patients had previously been treated with medical therapy and surgical middle ear ventilation without resolution. The MicroWick was placed directly in the eustachian tube orifice through a pressure-equalization tube. Patients received 3 drops of dexamethasone 4 mg/ml three times a day. The drops were discontinued after 4 weeks, and the MicroWick and ventilation tube were removed after 3 months. At study's end, eight patients (72.7%) reported subjective improvement in terms of a reduction in aural pressure and fullness. Audiometric testing demonstrated a 55% reduction in the mean air-bone gap and a 3% increase in the mean speech discrimination score. Bone pure-tone averages remained stable. Tympanometry showed that five patients (45.5%) converted from type B or C tympanograms to type A. Four patients (36.4%) had persistent perforations. Both patients with Samter's triad improved with therapy. These preliminary results suggest that direct dexamethasone administration to the eustachian tube is safe and effective for the treatment of chronic eustachian tube dysfunction. Long-term studies to confirm these findings are under way.     

The eustachian tube lumen in chronic otitis media

The measurements of the size of the eustachian tube lumen, in its various regions, in adults are presented. The material consisted of serially sectioned eustachian tubes of 26 normal temporal bones and four pathologic temporal bones, three of them with simple chronic otitis media and one with cholesteatoma. These measurements reveal: (1) in adults (as in children) that there is a considerable variance of the eustachian tube lumen sizes corresponding to other variations in sizes of other organs; (2) no obstruction of the eustachian tube lumen was encountered in any of the pathologic specimens; and (3) there was no significant statistical difference between the lumen size of the eustachian tube retrieved from normal temporal bones compared with those from temporal bones with chronic otitis media.     

咽鼓管功能障碍的慢性化脓性中耳炎治疗分析

目的 探讨合并咽鼓管功能障碍的慢性化脓性中耳炎病例的适宜手术方案。 方法 收集咽鼓管功能障碍的慢性化脓性中耳炎病例68耳,分为观察组(28耳),同期行中耳乳突手术及咽鼓管球囊扩张术,对照组(40耳),仅行中耳乳突手术。术前,术后3个月、6个月、12个月分别以ETDQ-7评分、听阈、气骨导差进行对比。 结果 观察组术后6~12个月随访气导平均听力改善率为89%(25/28),干耳率93%(26/28)。对照组听力改善率为75%(30/40),干耳率95%(38/40)。观察组术后3~6个月EDDQ-7评分及听阈达到较明显缓解,但术后6~12个月上述指标有加重趋势。观察组及对照组术后听力均比术前听力提高,有统计学差异,两组的术后听力相对比,观察组优于对照组,有统计学意义。 结论 在咽鼓管功能障碍的慢性化脓性中耳炎患者中,中耳手术同期咽鼓管球囊扩张术较单纯中耳手术的听力改善率高,改善程度高,重新内陷率低,重新粘连率低,干耳率无明显差别。术后3~6个月患者咽鼓管相应症状达到较明显缓解,6~12个月症状有反复。     

Ligation of eustachian tube for intractable patulous eustachian tube: a preliminary report

Pharyngeal orifice of the eustachian tube was ligated on ten patients, 15 ears with intractable patulous eustachian tube. While the eustachian tube orifice was observed by an endoscope inserted through the contralateral nostril, the orifice was ligated transnasally and/or transorally using instruments usually used in the endoscopic nasal surgery. Now 13–27 months after the surgery, the outcome was excellent (both symptoms and sonotubometry were normalized) in two ears, good (either symptoms or sonotubometry was improved) in seven ears, and unchanged in the remaining six ears. In one of the ears with an outcome of unchanged, the ligation was found to be spontaneously released soon after surgery, but the symptom was improved after the second operation 2.5 months after the first operation. Temporary otitis media with effusion was seen in one ear, mild inflammation around the ligated site also in one ear, but no other serious complication has been observed. Although further improvement in the surgical procedure and further discussion about its long-term outcome should be required, this procedure appeared to be one of the therapeutic options for intractable patulous eustachian tube.     

The eustachian tube muscles in otitis media. A comparison between eustachian tube muscles in healthy and inflamed ears

The cross-sectional area of the tensor palati (TP) and levator palati (LP) muscles in the mid-portion of the Eustachian tube was measured in serially sectioned histological specimens of 35 temporal bones (TB). 17 of the TBs presented acute or secretory otitis media. The other 18 TBs showed no evidence of inflammatory disease. No significant differences were found between the mean sizes of the muscles coming from TBs with acute and secretory otitis media and of those from TBs without signs of inflammation. The cross-sectional area of the LP was found to be significantly larger than that of the TP. These results raise the question as to the actual role of the muscles' size in inflammatory middle ear disease in infants and children, and as to the role of the LP.     

Mucociliary function of the eustachian tube in the eustachian tube dysfunction

Background: Most of the tests to evaluate the eustachian tube (ET) function are focused on the ventilation function of the ET.

Aim: Here we evaluate mucociliary function of the ET in patients with ET dysfunction.

Materials and methods: Ten patients with ET dysfunction were enrolled into the study. Six patients had chronic tympanic membrane retraction and four patients had chronic middle ear effusion (MEE). All patients had intact tympanic membranes. Tympanometry and clinical examinations were done to all patients. Mucociliary function was evaluated with technetium labeled albumin and blue dye. Tympanometry and clinical examinations were done to six patients with chronic tympanic membrane retraction and four patients with chronic middle ear effusion (MEE). Mucociliary function of the ET was evaluated with technetium labeled albumin and blue dye placed into middle ear through an intact tympanic membrane and followed from nasopharynx ET orifice (blue dye) and with gamma camera (technetium).

Results: Blue dye was observed in tubal orifice in six (6 of 10) patients during 30?min observation. Five of those patients (5 of 6) had tympanic membrane retraction and one patient (1 of 6) had MEE. Tracer activity decreased from middle ear in six (6 of 10) patients. Four of those patients had tympanic membrane retraction and two had MEE.

Conclusion: Mucociliary function of the ET seems to be better in patients with tympanic membrane retraction than patients with middle ear effusion.

Significance: Mucociliary function of the ET is an important function for middle ear aeration, blue dye test is easily available to be used also in clinical practice.     

Patulous eustachian tube syndrome: the relationship with sensorineural hearing loss. Treatment by eustachian tube diathermy

The patulous Eustachian tube syndrome has previously been regarded as a troublesome but benign condition. Nine out of 13 patients reported here had evidence of cochlear damage similar to that caused by acoustic trauma. These patients also had vestibular symptoms which improved with treatment of the patulous tube. It is postulated that abnormal patency of the Eustachian tube may allow excessive middle ear pressure changes to occur which may be transmitted by abnormal ossicular movement to the cochlea. Eustachian tube diathermy using a ureteric diathermy probe is a safe and effective method of treating this condition.     

Alternative treatment for otitis media with effusion: eustachian tube rehabilitation

In this study, we evaluated the effectiveness of eustachian tube rehabilitation (ETR) as treatment for otitis media with effusion (OME). Thirty-five children with persistent OME were enrolled. Patients were divided into three groups: group I (isolated OME); group II (OME and atypical swallowing); group II (OME, habitual mouth breathing and atypical swallowing). All children underwent ETR. Otomicroscopy and tympanograms were performed before treatment, and at one and three months following ETR. Considering the overall patient population after ETR (one and three months later), the prevalence of type A tympanogram increased significantly compared to before therapy (p < 0.005), while the prevalence of type B tympanogram decreased significantly (p < 0.005). We found significant differences between pre- and both post-therapy control in groups I and II. However, children in group II experienced significant improvement of middle ear conditions only three months after the end of therapy (p < 0.005). On the basis of the physiopathologic knowledge of OME and the underlying principles of ETR, we conclude that ETR can be considered a useful therapy in management of OME.     

Middle ear and eustachian tube lining in chronic otitis media.

By means of histological observations we have tried to find morphological data on which to classify non-suppurative and suppurative chronic otitis media. There was also evidence of pathophysiological features which may have direct influence upon the development and behaviour of chronic inflammations of the tympanic cleft, such as disorders of ventilation and reaction of the mucoperiosteal layer. Local defence mechanisms, the species and virulence of infection also play an important role. It appears that the Eustachian tube is a very effective mechanical and immunological barrier against ascending infection which may perhaps be assisted by antibiotic treatment. Certainly non-suppurative chronic otitis media is more frequent now than in pre-antibiotic days.     

Dermoid cyst of the eustachian tube.

We report a case of dermoid cyst of the Eustachian tube in a 2 1/2 -year-old-girl with CT and MRI imaging. This is the 12th described case of such a pathology. Most of the reviewed previous 11 cases affected females on the left side. The surgical approach and the contribution of CT and MRI are discussed.     

Transtympanic dilatation of the eustachian tube during chronic ear surgery

Conclusion: Evaluation of the protympanic segment of the eustachian tube is feasible during chronic ear surgery. Balloon dilatation of that segment yields a bigger aperture. Objective: To evaluate the feasibility of visualization and balloon dilatation of the protympanic segment of the eustachian tube during chronic ear surgery. Methods: This study was carried out on a consecutive case series. All patients undergoing surgical treatment for cholesteatoma or tympanic membrane perforation over a 6-month period of time at a tertiary hospital were evaluated intraoperatively for the ability to visualize the protympanic segment of the eustachian tube, perform balloon dilatation, and then perform visual inspection of the effect of dilatation. Results: A total of 21 chronic ear procedures were performed; visualization of the protympanic segment was feasible in 12 ears, obstruction was identified in 7 ears, and dilatation was undertaken. Immediate assessment showed increased aperture of the tube in all patients when compared with predilatation findings.     

The permeability of capillaries in the eustachian tube mucosa.

The transendothelial passage of horseradish peroxidase (HRP) and diffusion of HRP into the pericapillary space, injected intravenously into cats, was studied at the light and electron microscopic level in the mucosa of the eustachian tube. The permeability of capillaries in the pharyngeal two-thirds of the tube was higher than in the tympanic one-third though all the subepithelial capillaries were of the continuous type. In the lamina propria of the subepithelium in the pharyngeal two-thirds much HRP was found 10 min after its intravenous injection, but in the tympanic one-third, it was absent in the perivascular spaces. The capillaries of the pharyngeal two-thirds had many projections and marginal folds inside the capillary lumen and large pinocytotic vacuoles containing HRP as well as many micropinocytotic vesicles. On the other hand, the capillaries in the tympanic one-third had many micropinocytotic vesicles too, but only a few large pinocytotic vacuoles.