Most of the pathology that is responsible for Eustachian tube dilatory dysfunction has been observed within the cartilaginous portion and is most commonly due to inflammatory disease, which can be readily diagnosed with transnasal endoscopy. A careful assessment of the dynamics of the ET by endoscopy can be very effective in determining the etiology, location and severity of dilatory dysfunction within the functional valve in the cartilaginous portion. Disorders of dilation may be observed and classified. Inflammatory disease can be graded on a recently validated mucosal inflammation score instrument. The etiology of the inflammation can be investigated and treated, with the most common causes being infectious or reflux in younger children and over age 6, allergic disease, reflux, rhinosinusitis, adenoid hypertrophy and other commonly known causes of nasopharyngeal inflammation.
Treatment of the underlying medical conditions can result in improvement of ET function and resolution of middle ear disease. When the medical causes have been optimally treated, but ET dilatory dysfunction persists, possibly due to irreversibly injured mucosa, biofilms or other pathology, tympanostomy tubes are usually recommended. When tubes fail to resolve the problem, treatment of the underlying pathology with surgery can be offered. Surgery is tailored to the sites of inflammatory or obstructive pathology and may involve turbinate reduction, sinus surgery, adenoidectomy, or balloon dilation of the ET. All of these procedures are designed to remove irreversibly injured tissue and provide a fresh start, assuming the underlying medical conditions are adequately controlled. Failure to control the medical problems can lead to recurrence of inflammatory disease.
