OUR EXPERIENCE IN SURGICAL TREATMENT OF MUCOSAL HYPERTROPHY OF TORI TUBARII

Abstract

Puprose. Evaluation of the effectiveness of surgical treatment of mucous hypertrophy of tori tubarii by submucosal tissue destruction using Ho:YAG laser radiation. Materials and methods. The study involved 48 adult patients with symptoms of Eustachian tube dysfunction. The patency of the auditory tube was assessed by standard tests, the ETDQ 7 questionnaire, tympanometry, pure tone threshold audiometry, and endoscopic video recording of the results were performed. Surgical intervention was carried out by forming under the influence of pulsed radiation from a Ho:YAG laser with a frequency of 10 Hz and a pulse energy of 2 J, 4–6 tunnels with a depth of 5–7 mm in the hypertrophied mucous membrane of the torui tubarii along the posteromedial surface and 2 tunnels up to 3 mm up and down from the pharyngeal mouth of the auditory tube. The control periods after surgery were 1, 3 and 6 months. Results. A significant improvement in the results of the auditory tube according to ETDQ-7 was noted by 3 months after surgery in 71% of patients and in 84% by 6 months. By 6 months after surgery, type C tympanometry and clinically significant conductive hearing loss persisted in 8 and 5% of patients, respectively. The subjective feeling of fully performing the Valsalva test improved in 58% after 3 months and in 82% by the 6th month, and the Toynbee test in 42% and 64% in the 3rd and 6th months, respectively. In 16% of patients, despite a visual decrease in mucosal hypertrophy during endoscopic examination, signs of dysfunction remained according to ETDQ 7. There were no complications after surgical treatment during 6 months of observation. Conclusion. The use of endoscopic diagnosis of the nasopharynx in patients with signs of dysfunction of the auditory tubes in combination with functional tests and the ETDQ-7 questionnaire allows to determine the indications for the surgical treatment of hypertrophy of the mucous membrane of the tori tubarii using the Ho:YAG laser, the effectiveness of which in our study was 84%.