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Site of Eustachian Tube Obstruction in COM

Presenting Author: Muaaz Tarabichi

Published online by Cambridge University Press:  03 June 2016

Muaaz Tarabichi  and
Muaaz Tarabichi
Muaaz Tarabichi
Affiliation:
American Hospital Dubai
Muaaz Tarabichi
Affiliation:
American Hospital Dubai
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Abstract

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Learning Objectives: 1-Understand the existence of obstructive pathology in COM. 2-Learn how to evaluate for the site of obstruction. 3-Consider options for addressing obstruction within the proximal Eustachian tube.

Objective: To assess the patency of the proximal and distal segments of the Eustachian tube in patients undergoing surgery for chronic ear disease.

Study Design: Case study with control group.

Methods: All consecutive patients presenting for surgery for chronic ear disease in our practice over 14 months underwent preoperative Valsalva computed tomography (CT) and an attempt was made intraoperatively using angled rigid scopes to evaluate obstruction of the protympanic segment of the Eustachian tube. Endoscopic examination of the same segment in 19 cadaver ears served as a control group.

Results: Preoperative Valsalva CT showed patency of the distal one-third of the Eustachian tube in 51 of 53 ears. Intraoperative endoscopy allowed visualization of the protympanic opening of the Eustachian tube in 31/53 ears; 21/31 ears showed obstruction of the protympanic opening of the Eustachian tube.

Conclusion: A clear obstruction was more likely to be present in the protympanic opening of the Eustachian tube in the patient population undergoing surgery for chronic ear disease than in the cadaver control group, and equally likely to be present in the distal cartilaginous tube in patients as in the control population.