To date, research has shown that eustachian tuboplasty for the treatment of eustachian tube dysfunction is safe in conjunction with sinus surgery.
Explore this issue:July 2009
In the prospective study of 20 patients mentioned above, for instance, researchers evaluated microdebrider eustachian tuboplasty via a solely transnasal approach in patients with eustachian tube dysfunction. All patients also had sinonasal disease and received endoscopic sinus surgery at the same time as the eustachian tuboplasty.
After a mean follow-up of 13 months, 70% of patients reported improvements in symptoms of ear blockage. Mean pure tone average improved by 6 decibels, and abnormal tympanogram improved in 65%. Patients did not experience any surgical complications.
Although there has not been a direct head-to-head comparison, Dr. Metson noted that laser surgery appears to be just as effective as microdebridement for eustachian tuboplasty.
For example, in a prospective surgical trial (Otol Neurotol 2004;25:1-8), Dr. Poe and his colleague, Oskar Kujawski, MD, of the Eustachian Tube Institute in Geneva, Switzerland, evaluated outcomes in 108 eustachian tubes in 56 patients who underwent laser eustachian tuboplasty under general anesthesia through a combined endoscopic nasal and transoral approach. Patients had intractable eustachian tube dysfunction with either middle ear effusion or tympanic membrane atelectasis.
Dr. Kujawski used laser vaporization of mucosa and cartilage from the luminal posterior wall until he achieved adequate dilation. He also performed a laser myringotomy to provide middle ear aeration while packing the eustachian tube.
About 65% of ears had normal middle ear aeration at three years or longer. Patients did not experience any intraoperative complications. Postoperative complications included minimal peritubal synechia in about 8% of tubes and epistaxis in nearly 1% of tubes. About 6.5% of ears did not respond to treatment and required tympanostomy.
Another small prospective study (Laryngoscope 2003;113:583-91), of which Dr. Poe, Dr. Metson, and Dr. Kujawski were authors, found that laser eustachian tuboplasty was safe and efficacious in the treatment of intractable eustachian tube dysfunction.
The researchers studied 10 patients with chronic intractable otitis media with effusion, who were treated with unilateral laser eustachian tuboplasty. These patients had already undergone repeated tympanostomy procedures, which had failed.
The surgeons combined transnasal and transoral approaches and used a laser to vaporize mucosa and cartilage on the posterior wall of the tubal lumen. Patients received general anesthesia, and surgery was on a outpatient basis.
After six months, seven of the 10 patients were free of effusion. There were no intraoperative complications; postoperative complications were minimal peritubal adhesions and one intranasal synechia.