Shim Placement of Eustachian Tube for Patulous Eustachian Tube

By June 7, 2019

Huang, Huie1,2; Guo, Li3; Zhang, Chi1; Zheng, Meihui1; Cui, Yong1
1 Department of Otorhinolaryngology, Guangdong Provincial People’s Hospital, Zhong Shan Er Lu, Guangzhou, China;
2 Shantou University of Medical School, Shantou, China;
3 Department of Operation Room, Guangdong Provincial People’s Hospital, Zhong Shan Er Lu, Guangzhou, China.

Introduction :
To evaluate the efficacy and safety of shim placement of eustachian tube in patients with patulous eustachian tube (PET).

-Study Design :Retrospective case review
Setting :Tertiary referral center
Patients :Patients with medically refractory PET at least 6 months, was diagnosed according to the diagnostic criteria proposed by Eustachian Tube Committee of Japan Otological Society in 2016.
Interventions :Shim was made by an intravenous catheter, filled with bone wax.We made a new insertion guidance tool which is a curved suction tube originally used in the endoscopic sinus surgery, and an plastic bar can be inserted into the lumen of the suction tube to push the shim out. The transnasal or transoral approach were performed depending on the status of the nasal cavity under general anesthesia.The shim was advanced through the guidance tool slowly and atraumatically into the eustachian lumen from the nasopharyngeal orifice. Tympanostomy tube insertion was performed for three months to prevent otitis media with effusion  postoperatively in the non-local patients.

­-Main Outcome Measure :Autophony symptoms were scored as: 1) complete relief; 2) significant improvement, satisfied; 3) significant improvement, dissatisfied; 4) unchanged; 5) worse.
Results :Shim placement of eustachian tube was performed for 28 sides in 17 patients, among which 19 sides in 12 patients were performed tympanostomy tube insertion at the same time. The follow-up period was between 1 to 8 months. 17 sides had complete relief (60.71%); 6 sides had significant improvement and satisfied (21.43%). 5 sides had improvement but dissatisfied (17.86%);

Shim placement of eustachian tube is a minimally invasive surgical option for PET and can effectively relieve patulous symptoms.