Role of dynamic slow motion video endoscopy in etiological correlation between eustachian dysfunction and chronic otitis media: A case-control study

Abstract

Objective: To assess the role of dynamic slow motion video endoscopy (DSVE) for diagnosing eustachian tube (ET) dysfunction in the cases of middle ear disorders and to classify eustachian dysfunction into mechanical and functional for the purpose of systematic management of middle ear disorders. Materials and Methods: A prospective, case-control study was carried out on total 84 patients (168 ears) of whom 64 patients with ear complaints (total 95 ears) having middle ear disease was taken as cases. Remaining 20 patients without any ear and nasal complaints (40 ears) and the normal ears among the case group (33 ears) were taken as controls (total 73 ears). DSVE was performed in cases and controls to compare the incidence of eustachian dysfunction in the two groups. Tubal movements were classified into four grades depending on: (1) Appearance of tubal mucosa, (2) movements of medial and lateral cartilaginous lamina, (3) lateral excursion and dilatory waves of the lateral pharyngeal wall, (4) whether tubal lumen opened well or not and (5) presence of patulous tubes (concavity in the superior third of tube). Results: On correlating the DSVE findings of ET in both case and control group, 4 times higher incidence of abnormal ET dysfunction was obtained in cases of middle ear disorders as compared to controls (P = 0.001, odds ratio of 4.0852). We found that 29 tubes had mechanical type of dysfunction (Grades 2A and 3A), whereas 30 tubes had functional type of dysfunction (Grades 2B and 3B and patulous). Conclusion: There is a positive etiological correlation between eustachian dysfunction and chronic otitis media by DSVE. It provides valuable information regarding the structural and functional status of the pharyngeal end of the ET and in classifying the type of eustachian dysfunction into mechanical or functional, which has management implications.