Clin Exp Otorhinolaryngol.  2019 Nov;12(4):385-391. 10.21053/ceo.2018.01900.

Management of Acquired Cholesteatoma Associated With Patulous Eustachian Tube and Habitual Sniffing

• Choi SW
• Lee DJ
• Lee SH
• Oh SJ
• Kong SK

• KMID: 2462734
• DOI: http://doi.org/10.21053/ceo.2018.01900

Abstract

OBJECTIVES
To investigate the effect of surgical treatment with eustachian tube (ET) catheter insertion in patients with acquired cholesteatoma associated with patulous eustachian tube (PET) and habitual sniffing.
METHODS
Nine ears of nine patients (two men and seven women; age, 20 to 65 years; average, 37.9±12.0 years) of acquired cholesteatoma associated with PET and habitual sniffing who underwent cholesteatoma surgery with simultaneous additional ET catheter insertion were examined in this study. Successful treatment was defined as stoppage of sniffing, a relief of a PET handicap inventory-10 (PHI-10), an improvement of autophony grade and no cholesteatoma recurrence.
RESULTS
ET catheter insertion was performed in all ears. Follow-up duration ranged from 16 to 37 months (average, 25.4 months). Cases consisted of nine pars flaccida type (100%). All patients obtained relief from aural symptoms and stopped sniffing. Postoperative PHI-10 scores were significantly lower than preoperative scores (P<0.001). During an average follow-up of 25.4 months, no cholesteatoma recurrence has occurred to date. One patient developed otitis media with effusion (OME) post-catheterization; OME resolved spontaneously without treatment. Four patients had a consecutive ET catheter insertion on the other side to resolve PET-related aural symptoms.
CONCLUSION
In case of acquired cholesteatoma with PET and habitual sniffing, ET catheter insertion performed simultaneously with cholesteatoma surgery could help reduce aural symptoms and stop sniffing. Moreover, the procedure might help in preventing cholesteatoma recurrence.

Keyword

Cholesteatoma; Patulous Eustachian Tube; Habitual Sniffing

MeSH Terms

Catheters
Cholesteatoma*
Ear
Eustachian Tube*
Female
Follow-Up Studies
Humans
Male
Otitis Media with Effusion
Recurrence

Figure

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  Fig. 1. Image of bone wax filled “tripod”-shaped catheter.

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  Fig. 2. The estimated length from the isthmus to the bony orifice of eustachian tube (ET) is 16.1 mm (red line). The estimated length from the isthmus to the nasopharyngeal orifice of ET is 23.2 mm (white line). Isthmus of ET is located between the dilated visualized segment and the undilated nonvisualized segment of ET (arrow).

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  Fig. 3. The length of the catheter was 25 mm. The tip of the catheter passed the isthmus of the eustachian tube and partially obstructed the eustachian tube.

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  Fig. 4. (A) Temporal bone computed tomography 3 months after atticotomy and tympanoplasty type I with additional eustachian tube catheter insertion (right ear) showing good middle ear aeration and mastoid cavity pneumatization. Catheter (arrow) is located in the bony orifice of the eustachian tube. (B) Temporal bone computed tomography 12 months after atticotomy and tympanoplasty type I with additional eustachian tube catheter insertion (left ear) showing good middle ear aeration. Catheter (arrowhead) is located in the bony orifice of the eustachian tube.

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  Fig. 5. Changes in total patulous eustachian tube handicap inventory-10 (PHI-10) score before and after the additional eustachian tube catheter insertion. *P<0.001.

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