Surgical Management of Obstructive Eustachian Tube Dysfunction

PROGRAM DESCRIPTION: This course will discuss the latest developments regarding the nature of Eustachian tube dysfunction (ETD), pathophysiology and medical/surgical treatment with a focus on the most common problem, obstructive ETD. Updates in this rapidly growing field over the past year will be highlighted. There is increasing evidence that the middle ear and mastoid space is physiologically analogous to an accessory sinus, which shares similar respiratory mucosa and pathology with the nasal cavity and paranasal sinuses. The special sensory functions of the ear are optimized and protected by the Eustachian tube, which serves as a unique, long, curved and dynamic "ostium." The cartilaginous portion contains a functional valve that must open periodically to allow for ventilation and clearance of secretions. It must close competently in order to prevent reflux of material and sounds from the nasopharynx. Failure of one or more of these three functions, ventilation, clearance and prevention of reflux, constitutes Eustachian tube dysfunction (ETD), which represent a spectrum from obstructive to patulous dysfunction. The most common etiology of obstructive ETD is inflammation within the cartilaginous portion causing a functional obstruction. The initial management of obstructive ETD should be to try to identify its source and treat the inflammation appropriately if possible.
The course will emphasize methods of diagnosis, endoscopic identification of pathology with representative cases and targeted surgical treatment. It will build on the AAO-HNS Clinical Consensus Statement on balloon dilation of the Eustachian tube. Several balloon dilation devices are cleared by the FDA for adults and one device is cleared for ages 8 and above. Pediatric indications, techniques, special considerations and adjunctive procedures will be discussed.

OUTCOME OBJECTIVE 1: Describe mechanisms of Eustachian tube pathophysiology and be able to diagnose disorders, including differential diagnosis of aural fullness/otalgia

OUTCOME OBJECTIVE 2: Treat Eustachian tube disorders with appropriate medical therapy

OUTCOME OBJECTIVE 3: Assess surgical anatomy, pathology and indications for new surgical techniques

BACKGROUND STATEMENT: Surgical management of Eustachian tube obstructive dysfunction is a new field for otolaryngologic surgeons. This course will provide for more understanding of the pathophysiology, indications for surgery, surgical anatomy and techniques of surgery.

Comprehensive Otolaryngology Track Statement : Disorders of the Eustachian tube problem are most commonly treated by Comprehensive Otolaryngologists, although subspecialists such as Pediatric Otolaryngology, Rhinology and Otology also share a great interest in treating these conditions.