Ligation of eustachian tube for intractable patulous eustachian tube: a preliminary report

Abstract

Pharyngeal orifice of the eustachian tube was ligated on ten patients, 15 ears with intractable patulous eustachian tube. While the eustachian tube orifice was observed by an endoscope inserted through the contralateral nostril, the orifice was ligated transnasally and/or transorally using instruments usually used in the endoscopic nasal surgery. Now 13–27 months after the surgery, the outcome was excellent (both symptoms and sonotubometry were normalized) in two ears, good (either symptoms or sonotubometry was improved) in seven ears, and unchanged in the remaining six ears. In one of the ears with an outcome of unchanged, the ligation was found to be spontaneously released soon after surgery, but the symptom was improved after the second operation 2.5 months after the first operation. Temporary otitis media with effusion was seen in one ear, mild inflammation around the ligated site also in one ear, but no other serious complication has been observed. Although further improvement in the surgical procedure and further discussion about its long-term outcome should be required, this procedure appeared to be one of the therapeutic options for intractable patulous eustachian tube.

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References

  1. 1.

    Bezold F, in Bezold F, Siebenmenn F (1908) Textbook of otology for physicians and students. Translated by J. Holinger. EH colegrove Co, Chicago, pp 154–155

  2. 2.

    Bluestone CD, Cantekin EI (1981) Management of the patulous eustachian tube. Laryngoscope 91:149–152

    Article  CAS  Google Scholar 

  3. 3.

    Bylander AKH, Ivarsson A, Tjernstrom O, Andreasson L (1984) Middle ear pressure variations during 24 hours in children. Ann Otol Rhinol Laryngol 94(Suppl 120):33–35

    Google Scholar 

  4. 4.

    Cantekin EI, Doyle WJ, Phillips DC, Bluestone CD (1980) Gas absorption in the middle ear. Ann Otol Rhinol Laryngol 89(Suppl 68):71–75

    CAS  Google Scholar 

  5. 5.

    Doherty JK, Slattery WH (2003) Autologous fat grafting for the refractory patulous eustachian tube. Otolaryngol Head Neck Surg 128:88–91

    Article  Google Scholar 

  6. 6.

    Hergils L, Magnuson B (1985) Morning pressure in the middle ear. Arch Otolaryngol 111:86–89

    CAS  Google Scholar 

  7. 7.

    Kobayashi T, Yaginuma Y, Takahashi Y, Takasaka T (1996) Incidence of sniff-related cholesteatomas. Acta Otolaryngol 116:74–76

    CAS  Google Scholar 

  8. 8.

    Magnuson B (1978) Tubal closing failure in retraction type cholesteatoma and adhesive middle ear lesions. Acta Otolaryngol 86:408–417

    CAS  Google Scholar 

  9. 9.

    Ogawa S, Satoh I, Tanaka H (1976) Patulous eustachian tube; a new treatment with infusion of absorbable gelatin sponge solution. Arch Otolaryngol 102:276–280

    CAS  Google Scholar 

  10. 10.

    Proud GO, Odoi H, Toledo PS (1971) Bullar pressure changes in eustachian tube dysfunction. Ann Otol Rhinol Laryngol 80:835–837

    CAS  Google Scholar 

  11. 11.

    Pulec J, Simonton KM (1964) Abnormal patency of the eustachian tube; report on 41 cases. Laryngoscope 74:267–271

    CAS  Google Scholar 

  12. 12.

    Pulec JL, Hahn FW Jr (1970) The abnormally patulous eustachian tube. Otolaryngol Clin North Am 3:131–140

    CAS  Google Scholar 

  13. 13.

    Sato T, Kawase T, Yano H, Suetake M, Kobayashi T (2005) Trans-tympanic silicone plug insertion for chronic patulous Eustachian tube. Acta Otolaryngol 125:1158–1163

    Article  Google Scholar 

  14. 14.

    Senturia BH, Carr CD, Rosenblut B (1962) Middle ear effusions produced experimentally in dogs. III. Further studies concerning the pathogenesis of the effusions. Acta Otolaryngol 54:383–392

    CAS  Google Scholar 

  15. 15.

    Shambaugh GE (1938) Continuously open eustachian tube. Arch Otolaryngol 27:420–425

    Google Scholar 

  16. 16.

    Simonton KM (1957) Abnormal patency of the Eustachian tube; surgical treatment. Laryngoscope 67:342–359

    Article  CAS  Google Scholar 

  17. 17.

    Stroud MH, Spector GJ, Maisel RH (1974) Patulous Eustachian tube syndrome; preliminary report of the use of the tensor veli palatini transposition procedure. Arch Otolaryngol 99:419–421

    CAS  Google Scholar 

  18. 18.

    Takahashi H, Fujita A, Lee SH, Honjo I (1990) Experimental conditions for the development of persistent otitis media with effusion. Eur Arch Otorhinolaryngol 247:89–92

    Article  CAS  Google Scholar 

  19. 19.

    Tos M, Wiederhold M, Larsen P (1984) Experimental long-term tubal occlusion in cats. A quantitative histopathological study. Acta Otolaryngol 97:580–592

    CAS  Google Scholar 

  20. 20.

    Virtanen H, Palva T (1982) Surgical treatment of patulous eustachian tube. Arch Otolaryngol 108:735–739

    CAS  Google Scholar 

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Correspondence to Atsushi Takano.

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Takano, A., Takahashi, H., Hatachi, K. et al. Ligation of eustachian tube for intractable patulous eustachian tube: a preliminary report. Eur Arch Otorhinolaryngol 264, 353–357 (2007). https://doi.org/10.1007/s00405-006-0185-9

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Keywords

  • Eustachian tube
  • Gas exchange function
  • Patulous tube
  • Pressure regulation
  • Surgical treatment