Learning Objectives: Challenge the concept of Eustachian tube dysfunction. A study of the middle ear in unconscious, tracheotomized patients with severe brain damage who were unable to swallow, i.e., severely diminished ability to actively open the ET. Therapeutically Thoughts.
Background and Objective: The Eustachian tube (ET) is a conduit communicating the middle ear (ME) with the nasopharynx. The ET is usually passively collapsed, whereas its opening is an active process. The intermittent, transient ET opening is accepted as critical for maintaining ME pressure circa ambient pressure, i.e., keeping the normal ME function. Interference of fluid passage through the ET was termed “ET dysfunction”, implying the pathophysiology of chronic ME diseases, such as otitis media with effusion (OME), tympanic membrane atelectasis or development of cholesteatoma. Our objective was to study a unique group of patients with severely diminished ability to actively open the ET.
Patients and Methods: Unconscious, tracheotomized patients with severe brain damage who were unable to swallow, produce valsalva or yawn, and fed by gastric tubes were enrolled after obtaining an informed consent from the authorized guardian(s). Each patient underwent otoscopic examination, tympanometry, nasopharyngoscopy and evaluation of gag reflex and soft palate movement. Some patients underwent fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST).
Results: Of the 14 patients recruited, 11 were eligible and fully evaluated: nine males and 2 females, aged 18–79 years (average 53). The period of tube feeding and mechanical ventilation was 3–84 months (average 28). None had prior known or recorded otogenic illness. All patients lacked a gag reflex or palatal movement. Otoscopy of 22 ears revealed 10 with OME (45%, 5 patients) and 12 normal ears (55%, 6 patients). Tympanometry type B was documented in 11 ears, type As in 3 and A in 8.
Conclusion: Despite that all ears tested apparently had a dysfunctional ET, about half had a normal ME. This strongly reveals that the ET is an important but not the only factor maintaining and regulating ME pressure.
