title: Eustachian tuboplasty and shrinkage of ostial mucosa with new devices : Including a proposal of a classification system.
abstract: OBJECTIVE
  A new combined approach to Eustachian tube dysfunction (ETD) employing new minimally invasive devices is described.
  
  
  METHODS
  An anatomoclinical classification of ETD was conceived to allow correct categorization of patients and enable comparative studies to be performed. Herein, the authors report on their experience with a consecutive series of obstructive ETD patients treated by balloon dilation of the Eustachian tube using AERA (Acclarent, Menlo Park, CA, USA), combined with a quantic molecular resonance (QMR)-mediated rhinopharyngeal tubal ostial mucosa shrinkage technique with a dedicated "Mitto" hand piece (Telea, Sandrigo-Vicenza, Italy).
  
  
  METHODS
  A prospective study was conducted in 102 patients with ETD. Medical history, complete clinical ENT evaluation and oto-functional examinations were performed in all patients. In all cases, balloon dilatation of the Eustachian tube was performed via the transnasal approach under video-endoscopic control. This was followed by decongestion of the torus tubarius and the inferior turbinate by QMR, with immediate shrinkage of the mucosa of the turbinate and a reduction of the prolapse of the mucosal plica on the tubal ostium.
  
  
  RESULTS
  Comparison of pre- and postoperative oto-functional examinations revealed a significant improvement. The postoperative hearing symptoms were reduced in a statistically significant manner on the visual analog scale (VAS). It was possible to perform the postoperative "swallowing-opening-Toynbee-Valsalva" (SOTV) test in a significant percentage of cases compared to the preoperative test.
  
  
  CONCLUSIONS
  The combined surgical procedure of balloon tubodilation with simultaneous QMR-mediated shrinkage of the tubal ostial mucosa and reduction of the posterior portion of the inferior turbinate was found to be an effective, safe, and complete treatment for tubal dysfunction in the majority of patients.
authors.affiliation: Otorhinolaryngology Unit, S. Spirito Hospital, Lungotevere in Saxia, 1, 00193, Rome, Italy. ldirienzo@businco.net.
authors.forename: L
authors.initials: L
authors.lastname: Di Rienzo Businco
authors.affiliation: Otorhinolaryngology Unit, S. Volto Clinic, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Di Mario
authors.affiliation: Otorhinolaryngology Unit, S. Volto Clinic, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Tombolini
authors.affiliation: Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mattei
authors.affiliation: Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Lauriello
mesh_terms: D000158:Acoustic Impedance Tests; D005064:Eustachian Tube / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane; D011446:Prospective Studies; D014433:Tympanoplasty
keywords: Ear, middle; Eustachian tube; Hypertrophy; Inflammation; Otitis