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Any kind of inflammation of the inside tubal mucosa (reflux, allergy, infection, chronic rhino-sinusitis) provokes an oedema with excessive mucus secretion and leads to an obstructive dysfunction.
In a typical Patulous Eustachian Tube condition, we observe a widening of the Eustachian tube channel. Patulous Eustachian Tube (PET) or tube to open remains an ET dysfunction category, difficult to diagnose and to treat.
Preliminary measures are focused on medical treatment of any a pathologies known to be associated to Eusatchian tube dysfunction. In case of moderate tubal dysfunction, it is possible to train a real tubal rehabilitation.
A micro fibroscope coupled with a camera is introduced through a nostril until the entrance of the Eustachian tube. He can so move easily the head without losing the image of the Eustachian tube that he is working.
The Eustachian tube orifice is like a cleft, bordered by the convexity of the Tensor Veli Palatini Muscle at the front, and the concavity of the cartilage at the back.

The reduction of the edematous mucosa and hypertrophied cartilage increases the concavity facing the TVP muscle, and restores the lumen of the tube which allows ventilation of middle ear during TVP muscle contraction. Transposed LVP muscle brings forward cartilage and posterior wall to improve closure of the patulous tubal channel. We operate directly the Eustachian tube itself, for obstructive as well as patulous Eustachian tubes. The Levator Veli Palatini (LVP) muscle istransposed back to close up, passively in steady state and actively when contracting, both tubal walls in order to narrow patulous tubal channel. But in case of a simple cold, or in fast weather, or altitude changing as in airplane, driving in mountains or diving, as small as the inflammation or congestion is it may induce a real clinical ET dysfunction with all symptoms and pathologies.
Other symptoms of PET, such as tinnitus, fullness and ear blokage, can also be reported by patients suffering from obstructive ET dysfunction.
The patient is capable of acquiring sensation of his Eustachian tube, called proprioception also on separate tube. This differential diagnosis problem leads unfortunately to some surgeries proposed by well intentioned but inexperienced ENT surgeons.

We reach the operating field, Eustachian tube, without any injury by working through the nose and the mouth.
Therefore, we enable Eustachian tube’s visualization in real time working by retroactive video feedback process.
Myringotomy and insertion of a ventilating tube may provide temporary relief in some patients. Chronic upper respiratory inflammatory diseases are almost always associated with PET ; half of these patients report previous history of nasal or sinus surgery. Lasting improvement after this surgery confers to this surgery a curative and also a real prophylactic or preventive indication. Last epidemiological data indicates that PET results from obstructive ET dysfunction evolving over a long period of time.

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Comments to “Patulous eustachian tube dysfunction surgery”

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