Surgical Management of Eustachian Tube Dysfunction and Its Importance in Middle Ear Effusion

One of otology's most significant advances in this century has been the reintroduction by Armstrong1 of the concept and the technique for restoration of middle ear ventilation. Previous attempts by such legendary otologists as Toynbee2 and Politzer3 had been ineffective and short-lived. The consequences of ineffective ventilation of the tympanum have plagued otologists for many years. In many instances, adequate ventilation of the tympanum can be accomplished by appropriate medical management. In others it is necessary to ventilate the tympanum by maintaining a tympanic membrane perforation with a ventilating tube. Problem Otologists are confronted daily with patients whose ears are not functioning optimally because of poor middle ear ventilation and/or middle ear fluid. The middle ear fluid may persist as the residual from a middle ear infection which has not yet been completely treated. (Complete treatment would necessarily require restoration of hearing and eradication of fluid.) It has been estimated that 10% of patients with acute suppurative otitis media treated with appropriate antibiotics and oral or topical nasal vasoconstrictors, with or without initial myringotomy, have residual middle ear fluid.4 Recent data suggest that children with persistent otoscopic, tympanometric, and audiologic changes have restricted development of some auditory processing skills as well as distortion of integrational patterns.5 This was found even when the hearing loss for speech frequencies averaged only 30 dB. In addition to persistent middle ear fluid, otologists are concerned about middle ear vacuum associated with hearing loss or with middle ear atelectasis. The atelectasis is an especially disturbing problem because it is part of a continuum which may progress from asymptomatic middle ear vacuum through varying degrees of reversible atelectasis to irreversible atelectasis or adhesive otitis media (Figure).