Sudhoff Holger, Ay Nazli, Todt Ingo, Sauzet Odile, Bernal-Sprekelsen Manuel, Scholtz Lars-Uwe
Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty OWL, Bielefeld University, Campus Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany.
Department of Epidemiology and International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, Bielefeld, Germany.
Eur Arch Otorhinolaryngol. 2021 Jul;278(7):2219-2224. doi: 10.1007/s00405-020-06277-0. Epub 2020 Aug 14.
To determine the effectiveness of a soft-tissue bulking agent comparing novel approaches of Eustachian tube (ET) augmentation procedures: transpalatinatal Eustachian tube augmentation in local and general anesthesia versus an augmentation with velotraction under general anesthesia. The clinical endpoint was the resolution of symptoms related to unilateral patulous Eustachian tube dysfunction (PETD) requiring no additional revision augmentations.
Combined retrospective clinical chart review.
Tertiary referral center.
Patients suffering from PETD underwent one of the following procedures: Group (A) transpalatinatal soft-tissue bulking agent with infiltration/augmentation under local anesthesia in a sitting position, group (B) transpalatinatal soft-tissue bulking agent infiltration/augmentation under general anesthesia in the flat position or group (C) infiltration/transoral augmentation of the ET with velotraction under general anesthesia in a flat position. The requirement to repeat the procedure due to recurrence of any PETD-related symptoms was recorded and retrospectively analyzed.
A total of 50 procedures were executed in 50 patients with unilateral PETD. The necessity to perform a second procedure has analyzed a mean of 6 months postoperatively (range: 6-17 months). Compared to the transpalatinatal augmentation in local anesthesia (group A) (100% success rate), the 6-month failure rate was significantly higher for transpalatinatal augmentation under general anesthesia (group B) (80% success rate) and velotraction augmentation under general anesthesia (group C) (67% success rate). Patient cohort with transpalatinatal augmentation under general anesthesia required 20% and augmentation with velotraction under general anesthesia in 33% revision augmentation procedures reviewed at 6 months follow-up (mean follow-up 11.2 months).
Although all different approaches resulted in a reduction of PETD related symptoms, the transpalatinatal ET augmentation in local anesthesia achieved a statistically significant superior clinical improvement. A complete resolution of PETD related symptoms was obtained and required additional procedures. This improvement may be related to the intraoperative "feedback" by the patients in local anesthesia in the sitting position eliminating the necessity for repeated procedures.
通过比较咽鼓管（ET）增强手术的新方法来确定一种软组织填充剂的有效性：局部麻醉和全身麻醉下经腭咽鼓管增强术与全身麻醉下腭牵引增强术。临床终点是与单侧咽鼓管异常开放功能障碍（PETD）相关症状的缓解，且无需额外的翻修增强手术。
回顾性临床图表综合分析。
三级转诊中心。
患有PETD的患者接受以下手术之一：A组，坐位局部麻醉下经腭软组织填充剂浸润/增强术；B组，平卧位全身麻醉下经腭软组织填充剂浸润/增强术；C组，平卧位全身麻醉下腭牵引经口咽鼓管浸润/增强术。记录因任何PETD相关症状复发而重复手术的需求，并进行回顾性分析。
50例单侧PETD患者共进行了50次手术。分析得出二次手术的必要性平均在术后6个月（范围：6 - 17个月）。与局部麻醉下经腭增强术（A组，成功率100%）相比，全身麻醉下经腭增强术（B组，成功率80%）和全身麻醉下腭牵引增强术（C组，成功率67%）在6个月时的失败率显著更高。全身麻醉下经腭增强术的患者队列在6个月随访（平均随访11.2个月）时，20%需要翻修增强手术；全身麻醉下腭牵引增强术的患者队列在33%的翻修增强手术中需要翻修。
尽管所有不同方法都使PETD相关症状有所减轻，但局部麻醉下经腭咽鼓管增强术在临床上取得了统计学上显著更优的改善。PETD相关症状得到了完全缓解，且无需额外手术。这种改善可能与坐位局部麻醉下患者的术中“反馈”有关，从而无需重复手术。
