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A novel technique for patulous Eustachian tube augmentation

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objective

To determine the effectiveness of a soft-tissue bulking agent comparing novel approaches of Eustachian tube (ET) augmentation procedures: transpalatinatal Eustachian tube augmentation in local and general anesthesia versus an augmentation with velotraction under general anesthesia. The clinical endpoint was the resolution of symptoms related to unilateral patulous Eustachian tube dysfunction (PETD) requiring no additional revision augmentations.

Study design

Combined retrospective clinical chart review. Setting: Tertiary referral center.

Methods

Patients suffering from PETD underwent one of the following procedures: Group (A) transpalatinatal soft-tissue bulking agent with infiltration/augmentation under local anesthesia in a sitting position, group (B) transpalatinatal soft-tissue bulking agent infiltration/augmentation under general anesthesia in the flat position or group (C) infiltration/transoral augmentation of the ET with velotraction under general anesthesia in a flat position. The requirement to repeat the procedure due to recurrence of any PETD-related symptoms was recorded and retrospectively analyzed.

Results

A total of 50 procedures were executed in 50 patients with unilateral PETD. The necessity to perform a second procedure has analyzed a mean of 6 months postoperatively (range: 6–17 months). Compared to the transpalatinatal augmentation in local anesthesia (group A) (100% success rate), the 6-month failure rate was significantly higher for transpalatinatal augmentation under general anesthesia (group B) (80% success rate) and velotraction augmentation under general anesthesia (group C) (67% success rate). Patient cohort with transpalatinatal augmentation under general anesthesia required 20% and augmentation with velotraction under general anesthesia in 33% revision augmentation procedures reviewed at 6 months follow-up (mean follow-up 11.2 months).

Conclusions

Although all different approaches resulted in a reduction of PETD related symptoms, the transpalatinatal ET augmentation in local anesthesia achieved a statistically significant superior clinical improvement. A complete resolution of PETD related symptoms was obtained and required additional procedures. This improvement may be related to the intraoperative “feedback” by the patients in local anesthesia in the sitting position eliminating the necessity for repeated procedures.

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Acknowledgements

We thank Mrs. Birgit Planer for her valuable assistance and artist Harald Konopatzki for his outstanding illustrations. We would also like to show our gratitude and dedicate this paper to Mr. David Andrew Moffat, BSc, MA, MBBS, PhD, FRCS (1947-2020).

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty OWL, Bielefeld University, Campus Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany

    Holger Sudhoff, Nazli Ay, Ingo Todt & Lars-Uwe Scholtz

  2. Department of Epidemiology and International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, Bielefeld, Germany

    Odile Sauzet

  3. Department of Otorhinolaryngology, Head and Neck Surgery, University of Valencia, Valencia, Spain

    Manuel Bernal-Sprekelsen

Authors
  1. Holger Sudhoff
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  2. Nazli Ay
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  3. Ingo Todt
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  4. Odile Sauzet
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  5. Manuel Bernal-Sprekelsen
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  6. Lars-Uwe Scholtz
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Corresponding author

Correspondence to Holger Sudhoff.

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The authors declared no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This clinical study was accepted by the Klinikum Bielefeld ethical committee (3326-108).

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Informed consent was obtained from all individual participants included in the study.

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Sudhoff, H., Ay, N., Todt, I. et al. A novel technique for patulous Eustachian tube augmentation. Eur Arch Otorhinolaryngol 278, 2219–2224 (2021). https://doi.org/10.1007/s00405-020-06277-0

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  • DOI: https://doi.org/10.1007/s00405-020-06277-0

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