gms | German Medical Science

78. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

16.05. - 20.05.2007, München

Laser shaping of the distal eustachian tube – a prospective clinical study with long-term courses

Meeting Abstract

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 78th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Munich, 16.-20.05.2007. Düsseldorf, Köln: German Medical Science; 2007. Doc07hno062

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Veröffentlicht: 8. August 2007

© 2007 Sedlmaier et al.
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Introduction: Long-term eustachian tube dysfunction appears to be the etiologic origin of nearly all chronic inflammatory middle ear diseases. Middle ear and tympanic membrane interventions treat only the consequences of the dysfunction but not its cause.

Methods: In this prospective clinical study, fiber-guided laser ablation (810 nm diode laser, Lumenis, Germany) of the distal eustachian tube was performed in 38 adult patients with chronic mesotympanic otitis media (COM) (n=19), chronic tube dysfunction (TDF) (n=14), treatment-resistant secretory otitis media (SOM) (n=3), and adhesive processes (AHP) (n=2) who had pathological tube function tests (Valsalva, passive tube opening, tympanogram). The success was checked at a follow-up examination with tube function tests after eight weeks. The patients were reexamined after 12-32 months.

Results: The Valsalva test showed functional improvement in 26 of the 38 patients (68.4%) after two months. In the patients with COM, Valsalva showed improvement in 14 of 19 patients (73.7%); passive tube opening improved in 5 of 12 patients (41.7%). For the diagnoses of TDF, SOM and AHP, Valsalva was positive in 12 of 19 patients (63.2%) after the intervention; a tendency toward improvement was found for the air-bone gap in 10 of 19 patients (52.7) and for the tympanogram in 6 of 18 (33.4%). Valsalva showed improvement in 15 of 20 patients (75%) during the long-term follow-up.

Conclusions: : Minimally invasive shaping of the distal eustachian tube under topical anesthesia can be recommended for patients with the above-mentioned diagnoses who have pathological tube function tests. Prior to tympanoplasties and especially in revision procedures, the prerequisite for successful surgery can be optimized in 70 % of the patients. The placement of indwelling ventilation tubes in adults with recurrent SOM can also be avoided. The results remain stable for the next two years. Patients with tympanic ventilation problems due to rapid pressure changes (flying, diving) can also profit from the procedure.