A paper by Dr. Michaelides and a colleague provides protocols to use in the diagnosis of a patulous Eustachian tube using standard audiology equipment and a physical test, a method that is preferred over only using a patient’s medical history (J Am Acad Audiol. 2011;22:201-207).
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January 2016Reconstruction of the Obliterated Eustachian Tube
Reconstruction of the obliterated Eustachian tube is a fairly new procedure used in patients with highly specialized circumstances. The procedure involves making a hole in the tympanic membrane, passing a sinus guidewire down the Eustachian tube from the ear, opening up the Eustachian tube, and inserting a stent, Dr. Poe said.
Added Dr. Michaelides, “We can expand from repairing basic Eustachian tube dysfunction to more complicated situations.”
Dr. Poe has had good success with the intervention, which he has used on 15 patients. “These patients had an obliterated Eustachian tube that needed to be reopened,” he said. Causes included sinus surgery, an over-aggressive adenoidectomy from childhood, complete scarring of the Eustachian tube from connective tissue disease, and trauma from a gunshot. “In the past, there was no technology available to safely unblock the Eustachian tube,” he said. “Now this may be a possible alternative when other procedures aren’t expected to be effective.”
Although no studies evaluating the technique have been published to date, Dr. Poe is working to publish his results with the non-FDA-approved procedure.
Hope for the Future
Looking ahead, advancements in certain areas are particularly desirable. These include the ability to deliver balloons safely though the ear so that an ear operation and dilation of the Eustachian tube can be done simultaneously. In addition, Dr. Poe said that commercial shims are needed for the patulous so that non-FDA approved intravenous catheters are no longer needed. “We need more instruments, particularly diagnostic equipment for Eustachian tube dysfunction and instrumentation that enables procedures to be done in the office,” he said.
More research into Eustachian tube function, dysfunction, and pathogenesis of otitis media is needed. “If we determine that inflammation in the ccartilaginous Eustachian tube is the main cause for dilatory dysfunction of the Eustachian tube, then we should be able to treat the condition medically,” Dr. Poe said. “While surgical developments are great solutions in light of the fact that current medications don’t suffice, we are ultimately hoping to have medications that can treat the Eustachian tube for dilatory dysfunction.”
Karen Appold is a freelance medical writer based in Pennsylvania.