Eustachian Tube Resection in Expanded Endonasal Transpterygoid Approach Can Cause Dysfunction

by Linda Kossof •

CLINICAL QUESTION

In using the expanded endonasal transpterygoid approach (EETA) to access the middle and posterior fossa, what is the incidence of, and what factors contribute to, the need for myringotomy?

BOTTOM LINE

Eustachian tube (ET) resection during EETA can lead to ET dysfunction and require myringotomy postoperatively.

BACKGROUND: EETA provides access to the middle and posterior fossa through the pterygoid process. Although initially the ET was resected for this approach, there has been a recent focus on ET preservation via anterolateral translation and transposition to lessen complications such as ET dysfunction and subsequent need for a myringotomy.

STUDY DESIGN: Retrospective cohort study.

SETTING: Department of Neurological Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio.

SYNOPSIS: Researchers conducted a retrospective study of 91 patients (56% female, mean age 58 years) who underwent an EETA for skull base pathologies at a single institution between July 1, 2010, and August 1, 2020. Patient demographics, tumor characteristics, management of ET with resection versus transposition, and need for subsequent myringotomy were collected. The most common primary location for pathology was sphenoid sinus/sinonasal (16/91), followed by Meckel’s cave/middle/temporal fossa and pterygopalatine fossa (15/91). Of the 27 patients (29.7%) who required myringotomy before or after surgery, the highest rate was with tumors of the pterygopalatine fossa (8/15). The most common pathology was primary sinonasal cancer. Malignant pathology had the highest myringotomy rate compared to benign tumors (48.9% vs. 10.9%). Multivariate analysis suggested that only ET resection significantly correlated with the need for myringotomy; malignant pathology, use of radiation, and higher CPK classification were independently associated with a need for myringotomy following an EETA. Authors noted that although literature on use of ET transposition to avoid resection is growing, this approach also has its drawbacks, and its benefit is uncertain. Study limitations included its retrospective nature.

Citation: Damante MA, Magill ST, Kreatsoulas D, et al. Endoscopic endonasal transpterygoid approach and the need for myringotomy. Laryngoscope. 2024;134:1203–1207.