Poe Dennis S
Department of Otolaryngology, Children's Hospital Boston, and Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA.
Otol Neurotol. 2007 Aug;28(5):668-77. doi: 10.1097/mao.0b013e31804d4998.
The patulous eustachian tube (ET) seems to be caused by a longitudinal concave defect in the mucosal valve at the superior aspect of its anterolateral wall and causes troublesome autophony of one's own voice and breathing sounds. Patulous ET reconstruction was evaluated to analyze whether submucosal graft implantation to fill in the concavity within the patulous tubal valve may produce lasting relief of symptoms.
Prospective trial.
Tertiary referral center, ambulatory surgery.
Fourteen ETs in 11 adults with 1 or more years of confirmed continuous patulous ET symptoms refractory to medical care.
Endoluminal patulous ET reconstruction was performed in 14 separate cases using a combined endoscopic transnasal and transoral approach under general anesthesia. A submucosal flap was raised along the anterolateral wall of the tubal lumen up to the valve and mobilized superiorly off of the basisphenoid. The pocket was filled with autologous cartilage graft or Alloderm implant, restoring the normal convexity and competence to the mucosal lumen valve.
Autophony symptoms were scored as 1) complete relief; 2) significant improvement, satisfied; 3)significant improvement, dissatisfied; 4) unchanged; or 5)worse.
All 14 cases reported immediate complete relief of autophony. Results with an average follow-up of 15.8 months are as follows: 1 (7%) case had complete relief; 5 (36%) had significant improvement, satisfied; 7 (50%) had significant improvement, dissatisfied; and 1 (7%) was unchanged. There were no complications. Correlation between patulous ET and other conditions was strongest with previous tubal dysfunction. Autophony of voice, but not breathing sounds, was also found to be experienced by 17 (94%) of 18 patients with superior semicircular canal dehiscence syndrome and could be easily mistaken for patulous ET autophony.
Patulous ET seems to be caused by a concave defect in the tubal valve's anterolateral wall. Submucosal graft implantation to restore the normal convexity to the valve wall seems to provide lasting relief of symptoms. Long-term study is needed. It is important to differentiate between the autophony of semicircular canal dehiscence syndrome and patulous ET.
咽鼓管异常开放似乎是由其前外侧壁上部黏膜瓣的纵向凹陷缺损引起的，会导致令人困扰的自身声音和呼吸音自听过强。对咽鼓管异常开放重建术进行评估，以分析在异常开放的咽鼓管瓣膜内植入黏膜下移植物填充凹陷是否能持久缓解症状。
前瞻性试验。
三级转诊中心，门诊手术。
11名成年人的14条咽鼓管，有1年或更长时间确诊的持续性咽鼓管异常开放症状，且药物治疗无效。
在全身麻醉下，采用内镜经鼻和经口联合入路，对14例患者分别进行咽鼓管腔内重建术。沿咽鼓管腔前外侧壁直至瓣膜掀起黏膜下瓣，并向上从蝶骨基底游离。用自体软骨移植物或异体真皮植入物填充腔隙，恢复黏膜腔瓣膜的正常凸度和功能。
自听过强症状的评分如下：1）完全缓解；2）显著改善，满意；3）显著改善，不满意；4）无变化；或5）恶化。
所有14例患者均报告自听过强症状立即完全缓解。平均随访15.8个月的结果如下：1例（7%）完全缓解；5例（36%）显著改善，满意；7例（50%）显著改善，不满意；1例（7%）无变化。无并发症发生。咽鼓管异常开放与其他病症之间的相关性与既往咽鼓管功能障碍最强。18例上半规管裂综合征患者中有17例（94%）也出现了自身声音自听过强，但呼吸音未出现，且容易被误诊为咽鼓管异常开放自听过强。
咽鼓管异常开放似乎是由咽鼓管瓣膜前外侧壁的凹陷缺损引起的。植入黏膜下移植物使瓣膜壁恢复正常凸度似乎能持久缓解症状。需要进行长期研究。区分半规管裂综合征和咽鼓管异常开放的自听过强很重要。
