The Role of Eustachian Tube Dysfunction in Recurrent Chronic Otitis Media: A Cross-Sectional Study of Anatomical and Functional Variations.

: Recurrent chronic otitis media (rCOM) is a major cause of hearing impairment, often linked to Eustachian tube (ET) dysfunction. Anatomical abnormalities, such as ET narrowing and obstructions, and functional impairments, including poor pressure regulation, play significant roles in rCOM recurrence. This study aimed to (1) identify anatomical variations of the ET in patients with rCOM using high-resolution imaging; (2) evaluate ET functional status using tympanometry, tubomanometry, and ET function tests; and (3) assess the correlation between anatomical variations and functional impairments in predicting rCOM recurrence. : A cross-sectional study was conducted on 212 patients with rCOM and 212 controls. High-resolution CT and MRI were used to assess ET anatomy, while functional status was evaluated using tympanometry, tubomanometry, and Valsalva maneuver tests. Statistical analyses, including -tests, Pearson correlation, and Cox proportional hazards models, were applied to examine the relationship between anatomical and functional impairments and rCOM recurrence. : Significant anatomical differences were observed in the rCOM group, including ET narrowing (24.53% vs. 11.32%, = 0.014) and curvature (32.08% vs. 14.15%, < 0.001). Functional impairments were also more prominent in rCOM patients, with higher ET opening pressure (120.56 ± 14.34 dPa vs. 85.78 ± 12.98 dPa, < 0.001) and lower Valsalva maneuver success rates (62.32% vs. 89.56%, < 0.001). Cox regression indicated that anatomical and functional impairments significantly predicted faster recurrence (HR for tympanometry peak pressure = 1.56, < 0.001). : The ETs anatomical and functional impairments are significant predictors of rCOM recurrence. A combined assessment of these factors can improve diagnostic accuracy and guide more targeted interventions to prevent recurrence.