The number of patients with Eustachian tube dysfunction in chronic middle ear disease is overestimated

Introduction In chronic inflammatory diseases of the middle ear, it is assumed that the occurrence is related to restricted tubal function and is positively influenced by balloon dilatation of the Tuba auditiva Eustachii (BTE). We conducted a randomized clinical trial on the efficacy of BTE in patients with chronic otitis media and report here on initial findings after completion of recruitment ("last patient in").

Material and methods: Inclusion criteria for the monocentric, randomized, double-blind study were chronic otitis media, age over 18 years, negative Valsalva maneuver, impaired tube function in tube manometry and planned middle ear surgery independent of the study. Exclusion criteria included previous tube dilatations, technically unfeasible tube manometry and the presence of malformations of the cranium.

Results Out of 1621 patients underwent ear surgery between June 2015 and January 2020, 338 patients with hearing implant, 132 undergoing ear canal surgery, 239 undergoing tympanoscopy, stapesplasty or tympanoplasty for audiological indications, and 93 patients undergoing other surgery were excluded. Of the 819 patients with chronic middle ear disease, 198 were children, 43 had a problem with communication, 43 patients were excluded due to anatomical anomalies, past irradiation and 53 had already received tube dilatation. Of the remaining 482 patients, only 72 had a problem with the tuba auditiva and 350 (72.46 % ) showed normal tube function in terms of a positive Valsalva maneuver or measurement.

Conclusions Most patients with chronic middle ear diseases do not (no longer) have problems with the function of the Eustachian tube. Usual pathophysiological attempts at explanation must be critically questioned - also in the context of communication with patients.

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Artikel online veröffentlicht:
13. Mai 2021