5 - Surgery of Ventilation and Mucosal Disease

Abstract

Eustachian tube dysfunction (ETD), one of the most common conditions observed in otolaryngology, lies at the heart of a broad array of otologic diagnoses, including acute (and chronic) otitis media, chronic otitis media with effusion, acute (and chronic) serous otitis media, and tympanic membrane retraction. Chronic ETD can have long-lasting sequelae, including structural changes in the middle ear sound conduction mechanism, leading to hearing loss and chronic infection with otorrhea. While much is known about the anatomy and structure of the eustachian tube, we are just beginning to understand the physiology and pathophysiology of the bony-cartilaginous tube that connects the nasopharynx to the mesotympanum and ventilates the middle ear space. This chapter reviews the terminology of middle ear disease as it relates to ETD and presents evidence-based recommendations for the medical and surgical management of ETD and ventilation disease. As the title of the chapter implies, we address surgical management of ventilation disease, including its indications and contraindications, surgical technique, and complications of myringotomy with ventilation tube insertion, mastoidectomy, and balloon eustachian tuboplasty.