Eustachian Tube Institute

Welcome to the Eustachian Tube Institute web site which I hope you will find of interest. Eustachian Tube Surgery and general ENT information is presented here in several languages.
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ENT SURGERY

 

ENT SOLUTIONS and ENT SURGERY information

Preliminary measures are focused on medical treatment of any a pathologies known to be associated to Eusatchian tube dysfunction. As antibiotics for recurrent infections, antiallergics in case of allergy, nasal coeticoids for sever nose and sinus inflammation, antiacids for oesogastric reflux...

In case of moderate tubal dysfunction, it is possible to train a real tubal rehabilitation. The purpose of this treatment is not only to strengthen the Tensor Veli Palatini Muscle (TVPM), as well as the Levator Veli Palatini Muscle (LVPM), but to teach the patient how to manage them and develop a better coordination. The patient is capable of acquiring sensation of his Eustachian tube, called proprioception also on separate tube. He will be able to face conditions at risk, and notably during the diving. Therefore, we enable Eustachian tube’s visualization in real time working by retroactive video feedback process.

ENT Surgery

A micro fibroscope coupled with a camera is introduced through a nostril until the entrance of the Eustachian tube. To ensure a totally comfortable exam, it is sometimes useful to anaesthetize nasal cavity for a moment, with Naphazoline or Xylocaïne 5%.


 

VIDEO FEEDBACK TUBO THERAPY:


To improve the comfort of the patient, and by the same way, the success of the treatment, we place in front of his eyes video glasses Glasstron (Sony).

 




He can so move easily the head without losing the image of the Eustachian tube that he is working. This way to proceed is particularly appreciated by the childrens.

 



Video Feedback Tubo Therapy:


Location and action of the TVPM muscle.

 




Location and action of the LVPM muscle.

 

We start by explaining the physiologie and tubal dynamic and where are the main muscles which he has to learn to control. Then, we select a program of specially elaborated exercises basing itself on an exercise book intended for the training at home.



Left Eustachian tube in relaxed state and open.

 

 



SURGERY:

When conservative and medical treatments fail we consider the tubal surgery.

You will understand the surgical principles with this model. It’s a right Eustachian tube. Main structures involved in tubal opening are shown in different colours. The cartilage posterior (in grey) supports the entire system to avoid total collapse.

Ear Nose and Troat Surgery

TVP muscle, the main tubal muscle anterior (in dark pink), is covert by the anterior intra tubal mucosa (in dark blue), making together some physiological convexity of the anterior wall in relax state, as a mirror of the posterior cartilaginous concavity. Perfect contact of both of these walls ensure correct closure. This is the tubal.

When opening, the posterior wall (cartilage) is pushes back by contracting the LVP muscle. The anterior wall runs forward by contracting the TVP muscle, straightening the convex curve (dark blue), creating the channel and tubal aperture. It’s a complicated dynamic system, requiring perfect coordination of all structures. Any damage or muscular malfunction induces Eustachian tube dysfunction.

Today, we offer several surgeries to restore a normal Eustachian tube function.The goal isn’t anymore to by-pass sick Eustachian tube with a ventilation tube or grommet in the ear drum. We operate directly the Eustachian tube itself, for obstructive as well as patulous Eustachian tubes. It’s a minimal invasive micro endoscopic laser surgery. We reach the operating field, Eustachian tube, without any injury by working through the nose and the mouth. It requires a short general anesthesia. It can be done within the framework of ambulatory surgery. It can be already provided in older chidren than 3 years of age. Post operative care is simple and healing is fast. Lasting improvement after this surgery confers to this surgery a curative and also a real prophylactic or preventive indication.



Obstructive Eustachian tube surgery

 

 

 

 

Patulous Eustachian tube (PET) surgery

 



The Eustachian tube orifice is like a cleft, bordered by the convexity of the Tensor Veli Palatini Muscle at the front, and the concavity of the cartilage at the back. When the opening is not sufficient, we modify original parameters of the posterior wall (cartilage).

 


We shape the posterior wall by treating the edematous or hypertrophied mucosa and the underlying cartilage through a laser-assisted, trans-nasal and oral endoscopic approach with a diode laser.

 





The reduction of the edematous mucosa and hypertrophied cartilage increases the concavity facing the TVP muscle, and restores the lumen of the tube which allows ventilation of middle ear during TVP muscle contraction. This allows TVP contraction to be more effective in opening the ET lumen.

 

 

 

OBSTRUCTIVE EUSTACHIAN TUBE SURGERY:

Normal left Eustachian tube (endoscopique view).

Closer view of the tubal valve. Anterior wall (on right) is convex. Posterior wall (on left) is concave. Between, the dark vertical cleft (yellow arrow) is the Eustachian tube lumen. Edematous mucosa and hypertrophied cartilage at the posterior wall. The luminal curve is inverted, convex at the sick posterior wall. This is the target of the surgery.

PATULOUS EUSTACHIAN TUBE SURGERY (ENT SURGERY)

The goal of these micro endoscopic procedures is to restore the Eustachian tube function by narrowing both tubal walls, avoiding intra luminal mucosal injury. This surgery is only slightly invasive and is mostly provided under general anesthesia. The approach is made through the nose and the mouth and leaves no injury or wound.

In a typical Patulous Eustachian Tube condition, we observe a widening of the Eustachian tube channel. It may be consecutive to a lack of convexity of the anterior wall due to an atrophy of TVP muscle or / and a diffused atrophy of the tubal mucosa with / without an atrophy of the tubal cartilage.

Several surgical treatment have been described. Attempting to narrow the lumen by diathermy or silver nitrate cautery, extrinsic compression by paraffin, teflon, gelatine, sponge or collagen injection. Attempting to alter the function of palatal muscles. Occlusion of the bony Eustachian tube by an indwelling layered and occluding catheter. Myringotomy and insertion of a ventilating tube may provide temporary relief in some patients. None of these could show a relevant or permanent success rate.

In some early stages of light Patulous Eustachian tubes, we inject non-reabsobable solution (viscous gel of dextranomer microspheres, stabilized hyaluronic acid, collagen, ...) under the intra-tubal mucosa in anterior or posterior wall. This injection is provided under local/general anaesthesia with specific needles and may relieve the patient immediately.

 

 

Endoscopic view of a right
PET-posterior wall injection.


Atrophic posterior wall mucosa circled in red.






A : anterior tubal wall.
P : posterior tubal wall.


Early view after injection. Bulging injected
Blue arrow pointing to the injestion needle.

Posterior wall circled in green, closing the valve.

 

 

 

In case of failure / complicated PET

ENT SURGERY SOLUTIONS

 

PATULOUS EUSTACHIAN TUBE RECONSTRUCTION (PETR)

 

 

In cases of sever PET or previous injection’s failure,
we consider a real PET reconstruction surgery.

 

 

 

 

 

 

Reinforcement or remplacement of tubal cartilage with a free cartilaginous graft.

 

 

PETR

Transposed LVP muscle brings forward cartilage and posterior wall to improve closure of the patulous tubal channel.

A mucosal vascularized flap is inserted in the anterior wall, above the Tensor Veli Palatini (TVP) muscle in order to increase its bulging and anterior wall convexity.

Inferior edge of the cartilage is shaped with laser. The Levator Veli Palatini (LVP) muscle istransposed back to close up, passively in steady state and actively when contracting, both tubal walls in order to narrow patulous tubal channel.

This chapter contains only basic information intended to present a simplified overview of our standard Eustachian tube Surgery concept. It’s not a surgical manual. We decline any responsibility in using this chapter information for any patient’s treatment. A specific physician chapter is destined to interested ENT specialists and not initiated surgeons.