Explore this issue:July 2009
-Ralph Metson, MD
Researchers agree that further studies are needed to determine the long-term outcomes of eustachian tuboplasty for chronic obstruction. We think that the procedure has promise, although long-term studies are needed, said Dr. Poe.
It may be years before any problems recur to indicate that the eustachian tube surgery was not effective, explained Dr. Michaelides.
Because the surgery is still new, we’re trying to be careful and to work scientifically with academically rigorous publications, and we don’t want to make any false claims, said Dr. Metson.
Investigators also need to explore whether the eustachian tuboplasty is more effective in conjunction with sinus surgery, noted Dr. Metson.
Additionally, Dr. Poe and his colleagues are looking at the origin of eustachian tube inflammation in children and adults, said Dr. Poe. We’re looking for eustachian tube and middle ear biofilms, inflammation markers, proteins, and gene expressions, he said. They are also researching whether the procedure should be used in children.
In addition to conducting ongoing basic science research, investigators want to improve the efficacy of the procedure and possibly expand its indications, said Dr. Poe.
While research is ongoing, eustachian tuboplasty remains a simple technique that general otolaryngologists can perform, noted Dr. Poe. However, the procedure should be applied cautiously in clinical practice, and practitioners should preferably take a course to learn the surgery and the anatomy involved, he said.
The experience of general otolaryngologists performing the surgery in their patients will determine whether the procedure becomes widely accepted and is effective in the long term, added Dr. Metson. They are the ones who will end up deciding the value of eustachian tube surgery and not the academics, he said.
Eustachian tuboplasty is still in the early stages of being implemented in patients, but it continues to show promise, concluded Dr. Poe.
Patulous Eustachian Disease
Eustachian tuboplasty may also be used to treat patulous disease, a condition in which the eustachian tube channel opens abnormally, said Dr. Michaelides.
The patulous eustachian tube is due to a defect in the normally convex anterior-lateral wall that can be due to loss of volume with the mucosa, submucosa, Ostmann’s fat pad, cartilage, or tensor veli palatini muscle, explained Dr. Poe.