Is there an indication for septoplasty and conchotomy before tympanoplasty? Effects of nasal surgery on the eustachian tube.

Background: When tympanoplasty is to be done in a patient suffering from ch ronic otitis media, usually potential interactions between middle ear mucos a, Eustachian tube function, and the nose and nasopharynx are considered. P oor tubal function goes along with a diminished success rate of tympanoplas ty. On the other hand, pathological findings in the nose or the nasopharynx are often said to be responsible for inadaequate tubal function. Consequen tly, many authors feel that surgery of the nose should be performed before tympanoplasty if septal deviation or hypertrophy of the conchae is seen in a patient with chronic otitis media. Patients and Methods: In order to better understand interactions between na sal pathology and Eustachian tube function, we utilized a pressure chamber to examine 50 patients undergoing septoplasty and conchotomy. Besides insuf flation tests (Toynbee, Valsalva), we performed dynamic tubal examination w ith the dual-impedance method. Active parameters (positive and negative res idual pressure) and passive parameters (tubal opening and tubal closing pre ssure) were recorded as the chamber pressure was varied. The aim of our inv estigation was to test if surgery of the nasal septum and the conchae reall y improves tubal function, thus evaluating indications for septoplasty befo re tympanoplasty. In addition, we explored the early and the late consequen ces of nasal surgery on tubal function. This was done to find out the optim al postoperative period during which tympanoplasty could be performed follo wing septoplasty. Results: In many of the patients, insufflation tests were negative and dyna mic tubal parameters were outside normal value range before surgery of the nose. One week after surgery, active and passive parameters and insufflatio n tests even deteriorated in the majority of our patients. Six to 8 weeks a fter surgery, we observed a tendency towards normalization of tubal paramet ers. This was significant for tubal closing pressure, but not for the other parameters. Whereas passive tubal parameters showed considerable improveme nt in many patients, there was no real improvement of active tubal paramete rs in most patients. This tendency was observed several months after surger y of the nose as well. Despite this improvement of passive tubal function, we did not observe a complete normalization of mean values even after 4 to 6 months. In several patients (who were satisfied with functional results o f septoplasty) tubal parameters were even worse some weeks or months after nasal surgery, but this was not subjectively registered by our patients. Discussion: We conclude from our data that dysfunction of the Eustachian tu be frequently occurs in patients with deviation of the nasal septum and the conchae. Septoplasty and conchotomy worsen tubal function during the early postoperative period, lasting for at least one week. In a later period, im provement of tubal function may occur but in many patients no effects of na sal surgery on Eustachian tube can be measured. Thus, septoplasty before ty mpanoplasty cannot be generally recommended in all patients with septal dev iation. We suggest that it may be useful in cases with severe nasal patholo gy or chronic infection of the nose or the nasopharynx, if this is accompan ied by poor tubal function. We recommend analysis of Eustachian tube functi on before deciding on therapeutic management. Individual findings in the sp ecific patient should be the leading criteria in all cases. If septoplasty and conchotomia are done, tympanoplasty should not be performed in the same session or in the early postoperative period, but several months after nas al surgery.