Laser Eustachian Tuboplasty: Efficiency Evaluation in the Pressure Chamber

Objective: Laser Eustachian tuboplasty (LETP) with ablation of the epipharyngeal orifice of the Eustachian tube (ET) shows good results in clinical observation. However, to this day, there are no reports evaluating the surgical procedure with valid test methods. The purpose of this study was to test the effect of minimally invasive LETP by means of a pressure chamber ET function test. Study Design: Prospective surgical trial. Setting: Tertiary and university hospital. Patients: Thirty patients with a history of ET dysfunction during pressure changes were examined. Intervention: Minimally invasive LETP was performed with an 812-nm diode laser under local anesthesia as an outpatient procedure. Main Outcome Measure: The ET function was tested pre-operatively and postoperatively by pressure chamber ET function test. Eustachian tube closing pressure (ETCP) was evaluated as a measure of the tissue pressure of the ET. In cases of a severely impaired ET function, a "blocked" pattern was evident, and no measurement of ETCP was possible. Results: Before minimally invasive LETP, 17 patients showed a completely blocked pattern. Postoperatively, 13 patients of this group showed an improved ET function with a restored normal opening pattern (p < 0.001). The ETCP was reduced from 6.24 +/- 3.46 mbar preoperatively to 4.06 +/- 2.36 mbar postoperatively (p < 0.013). Conclusion: The results strongly indicate that the effect of minimally invasive LETP can be proven by measuring the ET function in a pressure chamber. Results must be interpreted in combination with clinical methods like Valsalva maneuver and tympanometry. Patients with ET dysfunction during pressure changes seem to benefit from the minimally invasive LETP.