Balloon Dilation Eustachian Tuboplasty for Dilatory Dysfunction With and Without Effusion: A Comprehensive Outcome Analysis

OBJECTIVE

This study aimed (1) to demonstrate the efficacy of balloon dilation Eustachian tuboplasty (BDET) for dilatory Eustachian tube dysfunction (ETD) and (2) to determine whether adjunctive ventilation tube insertion (VTI) is superior to myringotomy in relieving symptoms for patients with ETD and concurrent middle ear effusion (MEE) treated with BDET.

STUDY DESIGN

A retrospective cohort study.

SETTING

Tertiary care academic center.

METHODS

Patients with dilatory ETD undergoing BDET with a ≥6-month follow-up period were enrolled and evaluated mainly using Eustachian tube function (ETF) tests and Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7). Participants with concurrent MEE were further classified into 2 subgroups, BDET with VTI and BDET with myringotomy. An intergroup comparison and comprehensive outcome evaluation were performed.

RESULTS

In total, 35 patients with 50 symptomatic ears were enrolled. According to ETF test results, the normalized ETF rate was 94% on the last visit. The mean ETDQ-7 scores decreased significantly from 3.7 ± 1.4 to 2.0 ± 0.9 after interventions, with the most improvement in symptoms occurring for "ear fullness" and "muffled hearing." For the final visit, strong correlations among ETF tests, tympanometry, and Valsalva results were noted. The aforementioned assessment results did not significantly differ between (1) the patients with MEE and patients without MEE and (2) "BDET with VTI" subgroup and "BDET with myringotomy" subgroup.

CONCLUSION

BDET was effective for dilatory ETD, even in cases with concurrent MEE. For patients with ETD and MEE, further research is required to evaluate the benefits of adjunctive myringotomy with or without VTI.

[Clinical observation of chronic recurrent secretory otitis media in adults treated by balloon dilatation of Eustachian tube combined with myringotomy and catheterization]

Objective:To explore the clinical effect of balloon dilatation of the Eustachian tube combined with myringotomy and catheterization in treating chronic recurrent secretory otitis media in adults. Methods:100 cases（135 ears） of chronic recurrent secretory otitis media in our hospital from January 2018 to May 2020 were selected as the research objects, and were divided into two groups according to the random number table method, 50 cases（68 ears） in the control group and 50 cases（67ears） in the observation group. The control group received tympanostomy and catheterization, while the observation group received tympanostomy with catheterization and balloon dilatation of the Eustachian tube. The total effective rates, Eustachian tube dysfunction scores, Eustachian tube pressure R scores, pure tone thresholds, complication rates, scores of life quality and recurrence rates 1 year after operation were compared between the two groups. Results:The total effective rate was higher in the observation group than the control group（P<0.05）. Compared with pre-operation, the score of Eustachian tube dysfunction, the pure tone listening threshold of each frequency were lower and the Eustachian tube pressure R scores were higher in the two groups at 3 months, 6 months and 12 months after operation（P<0.05）; 3 months, 6 months and 12 months after operation, the scores of Eustachian tube dysfunction, the pure tone listening threshold of each frequency in the observation group were lower than those in the control group（P<0.05）, and Eustachian tube pressure R scores were higher than those in the control group（P<0.05）. Compared with the control group, the incidence of complications and recurrence rate 1 year after operation were lower in the observation group（P<0.05）. Compared with before operation, the scores of life quality in the two groups were higher at 3 months, 6 months and 12 months after operation（P<0.05）; 3 months, 6 months and 12 months after operation, the scores of life quality were higher in the observation group than the control group（P<0.05）. Conclusion:Tympanotomy combined with balloon dilatation of Eustachian tube can effectively improve the Eustachian tube function of adult patients with chronic recurrent secretory otitis media, it has impressiveclinical effects. On the one hand,it can be better to promote the recovery of patients' hearing and improve the clinical cure rate of patients; On the other hand, it reduce the occurrence of complications and disease recurrence greatly, so the quality of the patients' life were improved significantly.

Management Options for Patients With Nasopharyngeal Carcinoma Undergoing Cochlear Implantation

OBJECTIVES

Cochlear implantation (CI) has been successfully used to restore hearing in patients with severe to profound hearing loss. In addition to hearing loss, irradiated patients with nasopharyngeal carcinoma (NPC) also often have chronic otitis media and Eustachian tube (ET) dysfunction. These features may result in difficulties in CI. We conducted this study to review the management options for irradiated patients with NPC undergoing CI. Furthermore, we investigated the results of CI in irradiated patients with NPC with chronic otitis media and obstructive ET dysfunction, accordingly to different treatment strategies.

METHODS

We retrospectively reviewed the data of patients with NPC who underwent CI in our hospital between 2006 and 2020. All subjects were found to be eligible according to the following inclusion criteria: had NPC, received irradiation, underwent cochlear implant surgery, and had chronic otitis media with obstructive ET dysfunction.

RESULTS

A total of 9 patients with obstructive ET dysfunction and chronic otitis media underwent cochlear implant surgery. Seven patients with an inflamed ETs underwent a 2-stage operation. Two patients with obliterated ETs, we performed a single-stage CI surgery. Only 1 patient had otitis media effusion after the surgery.

CONCLUSION

With the proper management of chronic otitis media and ET dysfunction, cochlear implant is an effective treatment for irradiated patients with NPC when conventional hearing aids failed.

[Eustachian tube and its dysfunction related diseases' occurence and treatments]

Summary Eustachian tube is the bone-muscular pipeline of connecting nasopharynx with the middle ear,which plays the role of middle ear pressure regulation,the clearance of foreign bodies and protection.However,Eustachian tube dysfunction is closely related with occurence,development and prognosis of middle ear disease.Since the Eustachian tube is deep in hiding,narrow complex anatomical structures and lack of understanding to its physiological function and so on.For centuries,scientists have tried to use various methods to solve the problem of Eustachian tube dysfunction,but the results were often less than expected.Recently,with the wide application of high resolution CT,endoscopy and other technology,the knowledge of anatomy and physical function on Eustachian tube are becoming increasingly comprehensive.Additionally,some new techniques to treat dysfunction, mainly including laser eustachian tuboplasty and balloon dilation Eustachian tuboplasty,are also rapidly appeared.Now,these are summarized below.

[The clinical application of balloon dilation Eustachian tuboplasty in patients with Eustachian tube dysfunction]

Objective:To evaluate the clinical application of balloon dilation Eustachian tuboplasty (BET) in patients with Eustachian tube dysfunction (ETD). Method:Twenty-five patients who were diagnosed as ETD and reserved BET surgery were retrospectively analyzed in this study. Result:After 1-year's follow-up, among 25 ETD patients, the total cure rate was 55.9% and the effective rate was 85.3%. The cure rate and effective rate was 52.9% and 76.5% in the delayed opening of the ET group; 58.8% and 94.1% in the unopened group, which was higher than the other one. Conclusion:BET surgery is safe and effective in the treatment of BET patients.