Laser Eustachian Tuboplasty

Objectives Surgery on the eustachian tube for chronic eustachian tube dysfunction has been previously directed toward the bony isthmus and failed to produce lasting results. Dynamic video analysis demonstrates pathophysiology in the tubal cartilaginous portion. This study investigated a new endoluminal procedure that focused on the cartilaginous eustachian tube. Study Design Prospective surgical trial. Setting Tertiary care private practice and outpatient surgical center. Patients One hundred eight eustachian tubes with intractable eustachian tube dysfunction (middle ear atelectasis or effusion) in 56 patients underwent laser eustachian tuboplasty by the first author (O. B. K.) since 1997. Intervention Dynamic video analyses of eustachian tube function were performed perioperatively. Laser eustachian tuboplasties were performed unilaterally or bilaterally under general anesthesia through a combined endoscopic nasal and transoral approach to the eustachian tube nasopharyngeal orifice. Carbon dioxide or 980-nm diode laser vaporization of mucosa and cartilage from the luminal posterior wall was accomplished until adequately dilation was achieved and the tube was packed. A laser myringotomy for temporary middle ear aeration while the eustachian tube was packed was also performed during surgery. Main Outcome Measures There were two outcome measures: 1) the presence or absence of middle ear effusion or tympanic membrane atelectasis and 2) impedance tympanometry. In addition, dynamic videos were examined to rate the degree of visible opening of the tubal valve and effects on mucosal edema and muscular movements. Results Seventy-four (68.51%) ears achieved normal middle ear aeration at 1 year, 70 (71.42%) at 2 years, and 60 (65.21%) at greater than or equal to 3 years. There were no intraoperative complications. Postoperative complications were limited to minimal peritubal synechia in nine (8.33%) tubes and epistaxis in one (0.9%) tubes. Seven (6.48%) ears failed treatment and required tympanostomy tubes. Conclusion Laser eustachian tuboplasty is a new procedure that has demonstrated early promise in correcting intractable eustachian tube dysfunction with few complications. Further studies will be necessary to reproduce the results and establish the role of laser eustachian tuboplasty in the management of chronic intractable eustachian tube dysfunction.