Impact of Laser Eustachian Tuboplasty on Middle Ear Ventilation, Hearing, and Tinnitus in Chronic Tube Dysfunction

Abstract

Long-term Eustachian tube dysfunction (ETD) predisposes to various secondary middle ear diseases. Most surgical and prosthetical interventions on the Eustachian tube itself have proven to be ineffective, whereas middle ear surgeries treat the sequelae of ETD without major influence on the underlying tubal pathology. The purpose of our study was to evaluate the outcome of laser Eustachian tuboplasty (LETP) on tubal function and associated otological symptoms in topically anesthetized ETD patients with intact or perforated eardrums. In a prospective clinical investigation, outpatient LETP was carried out in 31 subjects with therapy-refractory chronic ETD. The study population comprised two groups: 16 patients with mesotympanic eardrum perforations diagnosed with noninflammatory chronic otitis media (COM) and 15 patients with intact eardrums including otitis media with effusion, adhesion processes, and dysfunctional pressure equalization. Clinical examination and data acquisition were performed 2 wks before LETP as well as 8 wks and 1 yr postoperatively. On COM patients, LETP was done at 10-wk intervals before the scheduled tympanoplasty. Assessment of clinical effectiveness was based on transnasal videoendoscopy, ear microscopy, tubal function tests (Valsalva maneuver and passive tubal opening), audio- and tympanometric measurements, and visual analog scales. Tansnasal, fiber-guided laser surgery was performed in contact mode using a semiconductor diode laser (λ = 830 nm, 4 W). We hypothesized that regulated laser ablation of hyperplastic mucosa at the epipharyngeal dorsal circumference of the tubal ostium could be effective in improving the associated symptoms such as dysfunctional pressure equalization, aural fullness, conductive hearing loss, and tinnitus. LETP resulted in persistent volume reduction of the posterior tubal circumference in all patients. Objective parameters revealed significant improvement of tubal function tests and middle ear ventilation in 62% of subjects after 8 wks (66% after 1 yr). Significant long-term reduction of conductive hearing loss was achieved in both patient groups. Besides, tinnitus loudness was significantly reduced in COM subjects after tympanoplasty. Visual analog scales showed very low values for intraoperative pain and discomfort and high scores for long-term overall patient satisfaction as well as improvement of the symptoms such as dysfunctional pressure equalization and aural fullness. Subjects with post-LETP Valsalva feasibility marked higher values for satisfaction and symptom improvement than patients without successful Valsalva maneuver. COM subjects scored higher in hearing improvement and satisfaction after LETP and successful tympanoplasty than patients with intact eardrums. Outpatient LETP seems to be a suitable, safe, easily applicable, and well-tolerated treatment option before (revision) tympanoplasties and in all investigated diseases developing from long-lasting pathologic middle ear ventilation. Minimally invasive shaping of the hyperplastic nasopharyngeal Eustachian tube under topical anesthesia seems to be effective in improving tubal function as well as the associated symptoms such as dysfunctional pressure equalization, aural fullness, and conductive hearing loss in otherwise therapy-refractory chronic ETD.