Comparison of Electrocoagulation Tuboplasty and Continued Medical Therapy for Treating Persistent Eustachian Tube Dysfunction With Hypertrophic Mucosa Disease

Objectives The objective of this trial was to compare outcomes of electrocoagulation tuboplasty and continued medical therapy for treating persistent Eustachian tube dysfunction (ETD) with hypertrophic mucosa disease in the Eustachian tube (ET) orifice. Study Design Prospective, case-control trial. Material and Methods Patients with persistent ETD were recruited and allocated to electrocoagulation tuboplasty and continued medical therapy groups. The ETD questionnaire-7 (ETDQ-7) score and objective parameters were compared between the groups at 6 and 12 months. Results The proportion of patients with a decrease in ETDQ-7 scores was greater in the electrocoagulation group than in the medical therapy group at the 6-month follow-up (53.49% and 34.38%, respectively; p = .158), but the difference was not statistically significant. However, at the 12-month follow-up, there was a significantly higher proportion of patients with a decrease in ETDQ-7 scores in the electrocoagulation group (88.37% and 40.63%, respectively; p = .001). Additionally, a significant difference was observed between the groups in terms of the proportion of patients who improved 12 months after the treatment (tympanometry: 72.09% and 9.38%, respectively; p = .001; air-bone gap: 79.07% and 25.00%, respectively; p = .001; tympanic membrane status: 62.79% and 0.00%, respectively). In addition, the proportion of patients with improvements in the ET inflammation score was significantly different between the groups at 6-month (67.44% and 34.38%, respectively; p = .009) and 12-month (93.02% and 34.38%; p = .001) follow-ups. No device- or procedure-related serious adverse events were reported in any patients. Conclusions Electrocoagulation Eustachian tuboplasty appears to be a safe and feasible procedure for adult persistent ETD with hypertrophic mucosa disease in the ET orifice, and is superior to continued medical management alone. The improvements in ETDQ-7 and objective parameters persisted for 12 months.

Otological Presentation of Obstructive Nasal Lesions: A Study of 50 Cases

Purpose: To analyze and realize the importance of the Eustachian tube dysfunction (ETD) in the pathogenesis of the middle ear infections as to raise the awareness amongst the Otolaryngologists consider the tubal dysfunctions in the management of the otitis media. Materials and methods: 50 patients of aural discharge, aural fullness, aural pain, hearing loss and tinnitus along with nasal obstruction were selected from July 2013 upto December 2013 in the outpatient department (OPD) of Otorhinolaryngology - Head and Neck Surgery dept. of Dhaka Medical College Hospital under a specific prospective study protocol. All patients of aural fullness, hearing loss, aural pain, tinnitus, aural discharge along with nasal obstruction with or without sore throat were included; patients of sensorineural hearing loss, primary external ear pathology, ear malignancy and congenital ear diseaseswere excluded. Results: 58% patients were below 20 years, 50% were children, 64% were male and 36% female. 62% patients got aural fullness, 60% hearing loss 40% mild, 14% moderate, 6% severe conductive and 8% mixed), 26% tinnitus, 32% aural discharge and 30% aural pain and amongst the patients of otitis media with effusion (OME), 100% got hearing loss, 73% aural fullness, 33% tinnitus, 27% aural pain and 13% dizziness. 78% patients got septal deviation, 58% hypertrophied inferior turbinates (HIT), 32% enlarged adenoids (EA), 62% allergic rhinitis, 26% acute upper respiratory tract infection (URTI), 4% nasal polyps and 48% sinusitis/mucosal thickening and amongst the children, 64% got enlarged adenoids, 56% HIT, 76% septal deviation (SD), 24% acute URTI, 4% antrochoanal polyp, 20% adenoid with HIT and 44% adenoid with SD. Regarding findings in the patients of enlarged adenoid, 37.5% patients got eustachian tube dysfunction (ETD) and 62.5% got hearing loss due to OME as well as acute otitis media (AOM), chronic otitis media (COM) and it showed that mild adenoid caused ETD occasionally on URTI but mild adenoid with HIT caused OME. Conclusion: The obstructive nasal lesions are intermingled with otitis media, so this association should be sought out and underlying nasal lesions must be managed if any as a part of treatment of the otitis media. Bangladesh J Otorhinolaryngol 2021; 27(2): 159-169

Outcome of Eustachian Tube Balloon Dilation in Children: A Systematic Review

Objective: Eustachian tube dysfunction (ETD) is a chronic entity that has been historically managed with adenoidectomy and ventilation tube insertion. Recently, balloon dilation of the eustachian tube has shown promising results in recalcitrant eustachian tube dysfunction. We reviewed the literature to determine the outcome of eustachian tube balloon dilation in children. Methods: A literature search was conducted for the period from 1990 to 2020 by searching several databases over a 1-month period (January 2021) according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews for Interventions. Primary outcome was defined as the success of the intervention determined by the resolution of symptoms, and secondary outcome was determined by revisions surgery and presence of complications. Results: Only 7 articles were identified based on our objectives and selection criteria. All studies included are retrospective cohort case series (Level IV) and 1 cohort of matched controls (Level III). A total of 284 patients were included in this review, with a mean age of 7.8 years. A total of 463 balloon dilation were performed either bilaterally or unilaterally. The most common finding of ETD is middle ear effusion in 5 studies. Balloon dilation of eustachian tube was second-line treatment in 6 studies and first-line treatment in 1 study. Improvement of symptoms was identified in all studies through various assessments performed. Revision surgery was performed in 1 study with no major complications reported. Conclusions: Balloon dilation of the eustachian tube may be considered as an alternative procedure following failed standard treatment in children. The quality of evidence is inadequate to recommend widespread use of the technique until a better-quality study has been completed. Future randomized controlled studies with a large sample size are warranted to determine the efficacy of this procedure amongst children.

Repeat Eustachian Tube Balloon Dilation Outcomes in Adults With Chronic Eustachian Tube Dysfunction

Objective With increased focus on surgical management of the eustachian tube, clarifying management decisions benefits patients and surgeons. In this study, we examine the value of repeating the balloon dilation of the eustachian tube (BDET) procedure in patients who did not improve after the initial BDET. Study Design Level IV retrospective review of 145 BDETs performed on 86 patients between January 1, 2014, and May 1, 2019, identified 10 patients who underwent BDET more than once. Setting Managed care community otolaryngology practice. Methods Demographic and outcome data were collected on both single and repeat BDET cohorts. Results The Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7) was used as the primary outcome measure when comparing single vs repeat BDET cohorts. Generally, the 2 cohorts were similar in terms of sex and age distribution. Tobacco use and radioallergosorbent test–positive results were greater proportionally in the repeat BDET cohort. Preoperative ETDQ-7 scores were similar in both cohorts. Single BDET patients overall showed significant improvement in ETDQ-7 scores. ETDQ-7 scores for repeat BDET patients who did not improve after the first procedure similarly did not demonstrate improvement after the second procedure. Conclusions Inevitably, some patients will not improve after an initial BDET procedure. The utility of a repeated BDET procedure should be considered in determining how to manage such failures. The results of this limited study suggest that patients who fail to improve meaningfully on ETDQ-7 scores after the initial procedure are unlikely to show substantial improvements after a repeated procedure.

An alternative treatment approach for patients with resistant otitis media with effusion and dysfunctional Eustachian tube: A pilot study with rapid maxillary expansion

ABSTRACT Objectives To determine whether dysfunctional Eustachian tubes of children with resistant otitis media with effusion (OME), ventilation tube placement indication, and maxillary constriction will recover after rapid maxillary expansion (RME). Materials and Methods The RME group consisted of 15 children (mean age: 10.07 years) with maxillary constriction, Eustachian tube dysfunction (ETD), and resistant OME. The control group consisted of 11 healthy children (mean age: 8.34 years) with no orthodontic and/or rhinologic problems. Recovery of Eustachian tube dysfunction was evaluated by Williams' test at three timepoints: before RME/at baseline (T0); after RME (T1); and after an observation period of 10 months (T2). The control group was matched to all these periods, except T1. Results In the control group, functioning Eustachian tubes were observed in all ears at baseline (T0), and tubes showed no worsening and no change during the observation period (T2) (P > .05). In the RME group, functioning Eustachian tubes were observed in eight of 30 ears and ETD was observed in the remaining 22 ears at baseline (T0). The RME group showed significant improvements in tube functions after RME and the observation period (P < .05). Fifteen of 22 dysfunctional ears recovered (68.2%) and started to exhibit normal Eustachian tube function after RME (T1) and the observation period (T2). Conclusions The findings suggest that ears having poorly functioning Eustachian tubes are restored and recovered after RME in most of children with maxillary constriction and resistant OME. Thus, RME should be preferred as a first therapy alternative for children with maxillary constriction and serous otitis media.

Does Eustachian tube function affect the outcome of tympanoplasty?

Background Eustachian tube function has been regarded as a significant factor in the successful outcome of tympanoplasty. Eustachian tube dysfunction has been attributed to many diseases of middle ear cleft ranging from otitis media with effusion to unsafe chronic otitis media. The aim of this study is to evaluate the effect of Eustachian tube function on outcome of tympanoplasty in safe chronic suppurative otitis media patients and detect the correlation between the type of the used graft and the outcome of tympanoplasty. This study included 60 randomly selected patients diagnosed with safe chronic suppurative otitis media. Eustachian tube function was tested with tympanometry and Toynbee’s test. All patients underwent tympanoplasty type I. Results Successful statistically significant outcome was observed in 83.3 % of patients with normal eustachian tube function, while in 60 % of patients with eustachian tube dysfunction (p < 0.05). Conclusion Eustachian tube function significantly affects the outcome of tympanoplasty surgery. No significant correlation was noted between the type of the used graft and the outcome of tympanoplasty.