6- 8 Nasopharyngeal tumors and other extrinsic masses can cause obstruction and malignant neoplasms are significantly more likely to cause middle ear effusion, which is usually serous rather than mucoid. However, scarring or altered anatomy may cause longer lasting or even permanent changes in function. 5 Aural symptoms, such as tinnitus, fullness, and otalgia, have been reported after orthognathic surgery typically lasting for 6–8 weeks possibly due to surgical edema. Scarring from an adjacent procedure such as adenoidectomy can affect the ET orifice. 1 Potential causes for total obliteration of the ET include trauma, surgery, and diseases affecting the nasopharyngeal orifice or cartilaginous portion of the ET. Total obliteration of the Eustachian tube (ET) prevents its functions of pressure equalization and clearance of secretions, leading to chronic middle ear problems. Larger studies with long term follow up are indicated. In this pilot study, ET reconstruction was found to be a safe and possibly effective procedure in patients with total obliteration of the ET from various etiologies. ConclusionsĬomplete occlusion of the cartilaginous ET can be associated with intractable mucoid effusion endoscopic examination should be considered in such cases. Etiologies of obliteration included scarring after sinus surgery, obstruction after maxillo-mandibular advancement surgery (two patients), bullous pemphigus, gunshot trauma, and previous patulous obliteration (two patients). There were no complications directly related to the procedure. Two patients (three Eustachian tubes) underwent successful reoperation. 89% of operated ears had no effusion at last follow-up. Follow-up ranged from 4 to 56 months (mean 30.9 months). Nine ETs (seven patients), ages 17–68 years (mean 37.9) underwent ET reconstruction. Main outcome measures were otomicroscopy results, absence of middle ear effusion, and nasopharyngoscopy showing patency of the ET orifice. In four cases an additional steroid-eluting propel stent was placed in the ET orifice. A temporary stent (angiocatheter filled with bonewax) was placed to maintain patency while healing. Patients underwent endoscopic transnasal/transoral reconstruction of the obliterated ET using transtympanic illuminated guidewire guidance. Patients with total obliteration of the cartilaginous ET, with intractable mucoid effusion causing repeated occlusion of tympanostomy tubes were included. To investigate the safety and early efficacy of a procedure for reconstruction of the obliterated Eustachian tube (ET).
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