Abstract
Objectives
To evaluate the safety and therapeutic efficacy of trans-tympanic catheter insertion (TCI) in patients with refractory patulous eustachian tube (PET).
Methods
TCI was attempted in thirty-six ears of twenty-nine patients with chronic PET refractory to conservative treatment. The catheter was inserted under local anesthesia in an operating room through the bony orifice of the eustachian tube (ET) to occlude the isthmus of the tube via a myringotomy site on the tympanic membrane. Patients were evaluated postoperatively by nasal endoscopy and by interview to document symptoms. Successful treatment was defined as complete relief or significant improvement plus satisfaction with treatment. Patients had no concurrent disease and did not undergo any additional surgical procedure.
Results
TCI was performed in all except one ear, in which it failed because of an abnormally narrow tympanic ET orifice. Follow-up durations ranged from 6 to 37 months, with an average of 19.3 months. Successful treatment of subjective autophony was achieved in twenty-nine (82.4%) of the thirty-five ears. Ventilation tube (VT) placement was performed in the two ears because of otitis media with effusion (OME) after TCI. In one ear, the inserted catheter was finally removed due to additional unilateral mastoiditis after VT extrusion.
Conclusion
TCI seems to be a minimally invasive and was used successfully to treat PET. The procedure had a good overall success rate and complications were rare in the long-term.
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Introduction
The eustachian tube (ET) is a complex hourglass-shaped osseocartilaginous structure that connects the nasopharynx and protympanum of the middle ear cavity, and is associated with the ventilation and overall health of the middle ear . The ET is normally closed but opens temporarily during swallowing or yawning . Patulous eustachian tube (PET) is defined as an abnormal opening of the valve of the ET at rest and results in symptoms of autophony, aural fullness, and hearing one’s own breathing sounds . Patients with PET also suffer from vestibular symptoms and hearing loss because PET allows excessive pressure changes to occur in the middle ear that can be transmitted to the inner ear by ossicular movement . A diagnosis of PET can usually be confirmed by visualizing outward movement of tympanic membrane during regular nasal expiration and inward movement during regular nasal inspiration . These movements indicate abnormal patency of the ET and the ability of air to pass to and from the nasopharynx into the middle ear . A number of medical and surgical options are available for patients with PET . Conservative, nonsurgical methods are diverse and include weight gain, topical estrogen, and insufflation with boric or salicylic acid . In addition, agents that cause swelling of mucosa at the pharyngeal orifice of the ET may be sprayed or instilled at this site. For those refractory to these conservative and medical methods, various surgical treatments may be considered, such as, injection of bulking agents, fat/cartilage plugging, ligation of the orifice, endoluminal cauterization, silicone plug insertion, and hamulotomy . These methods can be classified by treatment principal as narrowing, closing, or obstructing PET. In this paper, we introduce a TCI technique based on PET obstruction. The catheter applied was modified to hang at the bony orifice of ET. Furthermore, the catheter was designed to be easily removed or replaced by a larger catheter. This study was undertaken to evaluate the safety and efficacy of TCI in patients with chronic PET.
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