Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty OWL, Bielefeld University, Campus Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany.
Eur Arch Otorhinolaryngol. 2024 Apr;281(4):1693-1700. doi: 10.1007/s00405-023-08271-8. Epub 2023 Oct 17.
This study retrospectively evaluated the efficacy and versatility of reopening procedures for the permanent occlusion of the cartilaginous Eustachian tube (POET) by analyzing four consecutive cases.
The study included all patients diagnosed with POET who suffered from Eustachian tube occlusion and glue ear. A combined approach of endoscopic transnasal/transoral laser surgery was utilized to reopen the POET. This was subsequently followed by balloon dilation (BET) and stenting for a duration of six weeks. In one distinct case, the Eustachian tube orifice was approached via a transtympanic method, where a balloon catheter was placed. The primary outcome measures targeted the success rate of reopening, which was quantified using audiological outcomes and Eustachian tube patency verified by a positive Valsalva maneuver.
Four patients, with an age range of 14-62 years (mean age of 29.3 years), were subject to Eustachian tube reopening. The duration of follow-up varied between 10 and 24 months, averaging at 16.2 months. Notably, 75% of the surgically treated ears displayed no evidence of glue ear upon their last follow-up and showed restoration of Eustachian tube patency. The procedures were executed without any surgical complications. The causes for POET in these patients were heterogeneous: two were attributed to scarring post adenoidectomy, one to occlusion following orthognathic surgery and the remaining one due to prior radiotherapy treatment for squamous cell carcinoma located at the soft palate.
Total occlusion of the cartilaginous Eustachian tube may be linked to persistent middle ear diseases. It is imperative to conduct nasopharyngeal endoscopy in these cases. The findings from this study suggest that the Eustachian tube reopening procedure is predominantly effective and safe for patients with POET stemming from a variety of pathologies. Future research should focus on exploring advanced stenting devices and necessitate longer follow-up periods for comprehensive understanding.
通过分析连续 4 例病例，本研究回顾性评估了永久性阻塞性耳咽管（POET）再通术的疗效和多功能性。
该研究纳入了所有被诊断为 POET 并患有咽鼓管阻塞和胶耳的患者。采用经鼻/经口激光内镜联合方法对 POET 进行再通，随后进行球囊扩张（BET）和支架置入 6 周。在一个特殊病例中，通过经鼓室途径，放置球囊导管，接近咽鼓管口。主要观察指标为再通成功率，通过听力结果和咽鼓管通畅性的阳性瓦尔萨尔瓦动作来量化。
4 名患者年龄在 14-62 岁之间（平均年龄 29.3 岁），接受了咽鼓管再通术。随访时间在 10-24 个月之间，平均为 16.2 个月。值得注意的是，75%的手术治疗耳朵在最后一次随访时没有胶耳的证据，并且显示咽鼓管通畅。手术过程中没有出现任何手术并发症。这些患者 POET 的原因各不相同：2 例归因于腺样体切除术后的瘢痕形成，1 例归因于正颌手术后的阻塞，1 例归因于软腭鳞状细胞癌的放射治疗。
软骨性咽鼓管完全阻塞可能与持续性中耳疾病有关。在这些情况下，必须进行鼻咽内镜检查。本研究结果表明，对于源自多种病理的 POET 患者，咽鼓管再通术主要是有效和安全的。未来的研究应侧重于探索先进的支架装置，并需要更长的随访时间以进行全面了解。
