Radiofrequency Ablation Eustachian Tuboplasty for the Treatment of Chronic Otitis Media with Effusion and Premature Extrusion of the Tympanostomy Tube.

Abstract

Objective: This study evaluated the effects of radiofrequency ablation (RFA) eustachian tuboplasty on the treatment of chronic otitis media with effusion (COME), and associated complications, in patients with premature extrusion of the tympanostomy tube (TT). Materials and Methods: Tuboplasty and T-tube reinsertion were performed in 23 ears with COME, a history of premature TT extrusion, and thickened mucus. Tube retention, perforation closure, hearing improvement, and complications were evaluated. Results: All 23 patients with COME and previous premature TT extrusion had remarkable mucosal hypertrophic disease or mucosal polypoid changes in the posterior cushion or posterior wall in the nasopharyngeal eustachian tube (ET) orifice. All surgeries were completed within 20 minutes after general anesthesia and were performed in the operating room. Pre-and post-air-bone gap gain was 18.3 ± 2.5 dB. The TT was retained for at least 12 months in 19 patients, whereas intentional premature removal at postoperative 8 to 9 months was required in 2 patients and premature extrusion occurred in 2 patients. Thus, the tube retention success rate was 91.3% (21/23). Of the 21 ears with intentional removal, the perforation closure rate was 81.0% (17/21). None of the patients reported RFA-related serious adverse events or a patulous ET. However, a scar synechia of the anterior-posterior wall was seen in 1 ET orifice, and stenosis of the ET orifice in 4 patients. Conclusions: RFA eustachian tuboplasty combined with TT insertion is a simple and minimally invasive technique for the treatment of intractable COME in patients with a thickened mucosa of the nasopharyngeal ET orifice. This technique may prevent premature TT extrusion.