Mid-term evaluation of the surgical management of patulous Eustachian tube dysfunction: a STROBE observational study

• Published in: European archives of oto-rhino-laryngology Vol. 281; no. 6; pp. 2883 - 2891
• Main Authors: Boullaud, Luc, D’Andrea, Gregoire, Fabre, Roxane, AlShukry, Abdullah, Castillo, Laurent, Guevara, Nicolas, Vandersteen, Clair
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2024
• Subjects: Adult; Aged; Cartilage - transplantation; Durapatite; Ear Diseases - surgery; Endoscopy - methods; Eustachian Tube - physiopathology; Eustachian Tube - surgery; Female; Head and Neck Surgery; Humans; Hyaluronic Acid - administration & dosage; Hyaluronic Acid - therapeutic use; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Otologic Surgical Procedures - methods; Otology; Otorhinolaryngology; Quality of Life; Treatment Outcome; Patulous Eustachian tube; Autophony; Eustachian tube
• ISSN: 0937-4477; 1434-4726; 1434-4726
• DOI: 10.1007/s00405-023-08388-w

Introduction
Patulous Eustachian tube (PET) is a condition affecting approximately 0.3% to 6.6% of the population, with autophony being the predominant complain. The management of PET lacks a well-defined standard in the literature as no effective medical treatments have been documented but various surgical options are available. This study aims to report mid-term outcomes following surgical management of PET.
Materials and methods
All patients who underwent surgical intervention for PET between September 2017 and June 2022 were enrolled. Data encompassing general demographics, quality of life (GBI), and procedure-specific data were collected.
Results
A total of 30 PET cases (in 19 patients) underwent surgical intervention including 9 injections of hyaluronic acid, 13 fat injections, 6 endoscopic shim insertions, 1 cartilage graft, and 1 injection of hydroxy apatite. After an average follow-up of 22 ± 14 months, 16 cases (53%) achieved complete symptom relief, while 8 cases (26.6%) reported partial relief. Additionally, 11(36%) cases required multiple surgeries. No specific surgical technique demonstrated superiority. Quality of life improved in 77% of cases based on 10 out of 13 GBI collected. Recurrence of PET symptoms occurred on average 10.6 ± 9.7 months after initial surgery, with an estimated global risk of 75% at 3 years. Transient serous otitis media was observed in only 4 cases (13.3%).
Conclusion
Surgical intervention for PET was found to be effective, achieving complete symptom relief in 53% of cases and significantly improving quality of life 2 years post-surgery. However, a substantial portion of cases necessitated one or more re-interventions. The durability of effectiveness appears to diminish over time.