Improvement in Eustachian Tube Function after Endoscopic Sinus Surgery for Polypoid Chronic Rhinosinusitis

Abstract

Objectives: 1) Discuss the evidence for polypoid chronic rhinosinusitis causing Eustachian tube dysfunction and the role of endoscopic sinus surgery. 2) Demonstrate a case report of a patient with otologic complaints of Eustachian tube dysfunction showing that Functional Endoscopic Sinus Surgery (FESS) results in both symptomatic and objective improvement on tympanogram with Toynbee maneuver. Methods: A patient with polypoid chronic rhinosinusitis was assessed with two runs of tympanometry: a run before and after a Toynbee maneuver. The same test was repeated at 12 and 22 weeks after surgery. Results: Preoperatively, there was no shift in the tympanogram in either ear after the Toynbee maneuver. At the first post-operative visit, our patient demonstrated a shift in the tympanogram curve after a Toynbee maneuver in the left ear. At the second visit the patient demonstrated a shift in both ears. The patient also described subjective improvement in symptoms of Eustachian tube dysfunction. Conclusions: This case study demonstrates that endoscopic sinus surgery in patients with chronic rhinosinsitis can improve symptoms of Eustachian tube dysfunction. Improvement in Eustachian tube function can be demonstrated by vigorous testing by shifts in the tympanogram curve after pressurization using the Toynbee maneuver. This suggests that a large prospective study should be performed using subjective and objective measures of Eustachian tube function in patients with otologic complaints and chronic rhinosinusitis. We feel that this unique test is clinically relevant and uses equipment readily available in a standard office rather than more extensive that are restricted to research laboratories.