Twelve-month outcomes of Eustachian tube procedures for management of patulous Eustachian tube dysfunction

Objective: To determine the 12-month effectiveness of transnasal–transoral endoscopic surgical procedures for eliminating symptoms of patulous Eustachian tube dysfunction (PETD). Study Design: Retrospective chart review. Methods: Patients with medically refractory PETD underwent one of the following procedures: 1) shim (catheter) insertion, 2) calcium hydroxyapatite injection, 3) patulous Eustachian tube (ET) reconstruction, or 4) obliteration of the ET lumen. Time to recurrence of any PETD symptoms was recorded, and success was determined as complete symptom resolution at 12 months. The frailty model, an extension of the Cox proportional hazards model, was used for the survival analysis. Results: A total of 241 procedures were performed in 80 patients. Median duration of symptom relief after surgery was 5.0 months (interquartile range [IQR]: 1.1–15.5 months) and varied by procedure type, ranging from 3.0 months (IQR: 0.7–7.0 months) for calcium hydroxyapatite injection to 20.6 months (3.4–35.9 months) for obliteration. Compared to shim insertion, the risk of 12-month failure was significantly higher for calcium hydroxyapatite injection (hazard ratio [HR] = 2.18; 95% confidence interval [CI] 1.29, 3.67; P = 0.004) and patulous ET reconstruction (HR = 1.62; 95% CI 1.04, 2.52; P = 0.035). Patients undergoing shim insertion (52.2%) and obliteration (81.8%) were likely to require pressure equalization tubes or to have had otitis media with effusion. Conclusion: Although all procedures potentially resulted in symptom resolution, placement of a shim or obliteration of the ET lumen was more likely to achieve 12-month resolution of PETD symptoms and more likely to result in otitis media with effusion than hydroxyapatite injection or patulous ET reconstruction. Level of Evidence: Level 4 Laryngoscope, 129:222–228, 2019.