Eustachian tube endoscopy in patients with chronic ear disease

Objectives/Hypothesis: A paucity of research exists on trans-eustachian tub e endoscopy to evaluate the status of the eustachian tube, Fuller examinati on of the role of the eustachian tube in chronic ear disease is needed, par ticularly because the eustachian tube has been implicated in the chronicity and pathogenesis of chronic ear disease. Therefore the purpose of this stu dy was to evaluate the eustachian tube, based on observations from trans-eu stachian tube endoscopy, Study Design: Twenty-two adult patients with chron ic ear disease gave informed consent to participate in a prospective, trans -eustachian tube endoscopic investigation. Methods: Flexible, fiberoptic, n onarticulating (outside diameter of 0.5 mm) and articulating (outside diame ter of 1.0 mm) endoscopes (coherent fused bundle of 3,000 pixels) were empl oyed, The eustachian tube endoscopy was performed under general endotrachea l anesthesia as the initial part of a larger, otological surgical procedure for chronic ear disease. The endoscope was passed from the middle ear (tra nstympanic approach) to the nasopharynx, Results: The 0.5-mm endoscope pass ed entirely through the eustachian tube from the tympanic orifice into the pharyngeal orifice in 16% of the cases. Stenotic blockage occurred at the i nfundibulum in 37% isthmus in 42% and fossa of Rosenmuller in 5% of cases. The eustachian tube mucosa was abnormal in 64% of cases, The risk for abnor mal eustachian tube mucosa was four times greater for persons with long-sta nding disease (greater than or equal to 20 y) than for persons without long -standing disease (<20 y), The mean therapeutic efficiency of ossicular rec onstruction was higher for the subgroup with normal than for the subgroup w ith abnormal eustachian tube mucosa. Conclusions: The findings of trans-eus tachian tube endoscopy provide objective evidence concerning eustachian tub e status in persons with chronic ear disease and have implications for the timing of surgical intervention (ossicular reconstruction).