Dynamic slow motion video endoscopy in eustachian tube assessment☆

Abstract 

Purpose

The aim of this study was to find out if there is a correlation between dynamic video endoscopic study of eustachian tube (ET) with middle ear disease and to grade ET movements based on dynamic slow motion video endoscopy (DSVE) findings and to determine if DSVE can be used as a useful tool to evaluate tubal function.

Materials and methods

A prospective, case control study was performed on 124 ears in 69 subjects who came to the ears, nose, and throat outpatient department. Transnasal endoscopic examination of the nasopharyngeal opening of the ET during rest, swallowing, and yawning was carried out to study its dilatory movements.

Results

In the control group, among the 61 ears studied, 37 ETs were found normal and 24 tubes, dysfunctional. In ears with middle ear disease (case group), 63 ETs were studied. Ten were found normal, and the remaining, dysfunctional. Ten patulous tubes were observed in this study: 3 in the control group and 7 in the case group. Tubal movements were classified into 4 grades depending on (1) appearance of tubal mucosa, (2) movements of the medial and lateral cartilaginous lamina, (3) lateral excursion and dilatory wave of the lateral pharyngeal wall, and (4) whether tubal lumen opened well or not. Upon correlation of results obtained on DSVE with middle ear disease, the P value was less than .0001, suggesting a significant relationship between the 2. Dynamic ET endoscopy findings of 121 ears (of the total 124 ears studied) were correlated with middle ear manometric studies using Mc Nemar χ² test. Seventy-five ears showed complete agreement, and 46 ears showed disagreement. The P value was found to be .000, showing a strong association between the 2 tests. On correlating dynamic ET endoscopy findings in 60 of 63 ears in the case group with middle ear manometry, we noticed that 38 ears showed complete agreement and 22 ears showed disagreement. The P value was found to be .007, which again showed significant agreement between the 2 tests.

Conclusion

Dynamic slow motion video endoscopic analysis of ET is a potentially useful tool in the quest for further understanding the pathophysiology of tubal dysfunction. We have attempted to grade ET movements based on severity of tubal pathology. We conclude that DSVE is a vital tool in diagnosing ET dysfunction in patients with middle ear disease. Additional study is required to assess the role of DSVE in predicting outcome after middle ear surgery.