Eustachian Tube Endoscopy in Patients With Chronic Ear Disease

Abstract

Objectives/Hypothesis: A paucity of research exists on trans-eustachian tube endoscopy to evaluate the status of the eustachian tube. Fuller examination of the role of the eustachian tube in chronic ear disease is needed, particularly because the eustachian tube has been implicated in the chronicity and pathogenesis of chronic ear disease. Therefore the purpose of this study was to evaluate the eustachian tube, based on observations from trans-eustachian tube endoscopy. Study Design: Twenty-two adult patients with chronic ear disease gave informed consent to participate in a prospective, trans-eustachian tube endoscopic investigation. Methods: Flexible, fiberoptic, nonarticulating (outside diameter of 0.5 mm) and articulating (outside diameter of 1.0 mm) endoscopes (coherent fused bundle of 3,000 pixels) were employed. The eustachian tube endoscopy was performed under general endotracheal anesthesia as the initial part of a larger, otological surgical procedure for chronic ear disease. The endoscope was passed from the middle ear (transtympanic approach) to the nasopharynx. Results: The 0.5-mm endoscope passed entirely through the eustachian tube from the tympanic orifice into the pharyngeal orifice in 16% of the cases. Stenotic blockage occurred at the infundibulum in 37%, isthmus in 42%, and fossa of Rosenmüller in 5% of cases. The eustachian tube mucosa was abnormal in 64% of cases. The risk for abnormal eustachian tube mucosa was four times greater for persons with long-standing disease (>20 y) than for persons without long-standing disease (<20 y). The mean therapeutic efficiency of ossicular reconstruction was higher for the subgroup with normal than for the subgroup with abnormal eustachian tube mucosa. Conclusions: The findings of trans-eustachian tube endoscopy provide objective evidence concerning eustachian tube status in persons with chronic ear disease and have implications for the timing of surgical intervention (ossicular reconstruction).

Endoscopic examination of the nasal cavity and nasopharynx in patients with otitis media

“…Otitis media with effusion is closely correlated to the presence of middle ear pathogens in the nasopharynx. [5,11] Based on these finding, tuba edema and purulent secretion in nasopharynx accompanied by sinusitis were significantly higher, while the size of adenoid vegetation were not significant between the children with OME and controls. This may be a strong evidence for Wang et al [12] reported that major pathological findings associated with tubal dysfunction were nasopharyngeal inf lammation.…”

“…[7] Today, factors and pathologies which are responsible for etiopathogenesis of otitis media have been evolving in favor of patient demographics. [5] Previous studies mostly reported bilateral OME in children and males, particularly. [8] There are many studies on the etiopathogenesis of OME in children in the literature.…”

“…Abnormal mucus may result in an increased risk of chronic disease in the long-term and individual treatment should be tailored accordingly. [5] Moreover, viral or bacterial infections of the upper airway are not only associated with AOM, but also with chronic suppurative otitis media. In the past, nasal obstruction secondary to rhinitis, deviated septum, polyps and sinusitis were associated with OME.…”

“…[5] An underlying absence of middle ear aeration due to ET dysfunction is also considered to be a culprit for cholesteatomas, chronic tympanic membrane perforation and atelectasis. [5] Endoscopic examination offers direct visualization of the nasal and nasopharyngeal space as well as of the size and condition of the adenoid tissue, the condition of the nasopharyngeal orifice of the ET and the pathology of septum and turbinates. The area of the nasopharynx has been measured by several methods.…”

To Assess the Efficacy of Modality Slow Motion Dynamic Video Endoscopy of Eustachian Tube in Chronic Middle Ear Pathologies

“…The Hopkins rod telescopes yield the best images with superior resolution, compared with the fiberoptic images. It is easier to pass the flexible scopes, but we preferred the 4-mm rigid scopes because of their high quality resolution [7].…”