Eustachian Tube Function and Habitual Sniffing in Middle Ear Cholesteatoma

Objective: To investigate the incidence of habitual sniffing and the function of eustachian tube in middle ear cholesteatoma. Study Design: Prospective study. Setting: University hospital. Patients: One hundred thirteen consecutive cases of primary acquired cholesteatoma were operated on from July 2005 to December 2007, and they consisted of 78 pars flaccida type (69.9%), 25 pars tensa type (22.1%), and 10 unclassified large type (8.8%). As a comparison, 178 consecutive cases of chronic otitis media (COM) and 30 consecutive cases of otosclerosis were also examined. Methods: A questionnaire was administered regarding symptoms of patulous tube and habitual sniffing to alleviate ear symptoms. Eustachian tube function was examined by sonotubometry. Results: The eustachian tube function in cholesteatoma showed patulous type (25.7%), stenotic type (44.2%), and normal type (30.1%), whereas that in COM showed 11.2%, 25.3%, and 63.5%, respectively, and that in otosclerosis showed 6.7%, 16.6%, and 76.7%, respectively. The incidence of patulous type is significantly higher in cholesteatoma than in COM (p < 0.01) and in otosclerosis (p < 0.05). Habitual sniffing was found to be significantly higher in cholesteatoma (31/113, 27.4%) than in COM (9/178, 5.1%) (p < 0.001) and in otosclerosis (1/30, 3.3%) (p < 0.001). The existence of diseases on the contralateral side was significantly higher in cases with habitual sniffing (26/31, 83.9%) than in those without habitual sniffing (32/82, 39.0%) (p < 0.001). After the canal wall up method, postoperative retraction of the eardrum is significantly related to habitual sniffing continuing after the surgery. Conclusion: Patulous eustachian tube and habitual sniffing may play a role for pathogenesis of middle ear cholesteatoma.