title: Laser eustachian tuboplasty: a preliminary report.
abstract: OBJECTIVE
  Surgical correction of eustachian tube dysfunction remains an elusive challenge. Repeat ventilation tube placement is often inadequate to prevent tympanic membrane and middle ear complications. Endoscopic analyses of eustachian tube dynamics have localized the site of primary pathophysiology to within the cartilaginous tube. The study investigated the feasibility, safety, and efficacy of a new endoluminal eustachian tube operation for the treatment of eustachian tube dysfunction.
  
  
  METHODS
  Prospective, institutional review board-approved surgical trial in a tertiary-care medical center.
  
  
  METHODS
  Ten patients with more than 5 consecutive years of intractable otitis media with effusion recurring after two or more tympanostomy tube placements were treated with unilateral laser eustachian tuboplasty. Surgery was performed on an outpatient basis with the use of general anesthesia and combined both transnasal and transoral approaches. A 980-nm diode or argon laser was used to vaporize an appropriate amount of mucosa and cartilage on the posterior wall of the tubal lumen. Preoperative and postoperative dynamic video eustachian tube function analyses were compared. Outcome measures were presence or absence of middle ear effusion and impedance tympanograms.
  
  
  RESULTS
  Five patients had at least 12 months of follow-up, and three of them had absence of any effusion (60%). Two patients had recurrence of their otitis media with effusion and required tympanostomy tubes again. Five patients had at least 6 months of follow-up, and four of them had absence of any effusion. The remaining patient had recurrence of otitis media with effusion and received a tympanostomy tube again. Overall results for all 10 patients after 6 months were 7 free of effusion (70%). There were no intraoperative complications. Postoperative complications were limited to minimal peritubal adhesions and one intranasal synechia.
  
  
  CONCLUSIONS
  Preliminary results suggest that laser eustachian tuboplasty is safe and efficacious in the treatment of intractable eustachian tube dysfunction. Further study will be necessary to determine whether laser eustachian tuboplasty is a suitable alternative to repeated tympanostomy tube placement in selected patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA. dpoe@massmed.org
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Poe
authors.forename: Ralph B
authors.initials: RB
authors.lastname: Metson
authors.forename: Oskar
authors.initials: O
authors.lastname: Kujawski
mesh_terms: D000158:Acoustic Impedance Tests; D000328:Adult; D004427:Ear Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D005064:Eustachian Tube / Q000503:physiopathology* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008876:Middle Ear Ventilation; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000295:instrumentation*; D011183:Postoperative Complications; D011446:Prospective Studies; D012720:Severity of Illness Index