Classification, diagnosis and treatment of Eustachian tube dysfunction literature review

Introduction: The Eustachian tube (ET) is the anatomical structure that connects the middle ear with the nasopharynx. It is part of a system that, in addition to the already mentioned elements, also includes the soft palate. The functions of ET are pressure equalization, clearance of secretions and protection of the middle ear from sounds and reflux of secretions from the nasopharynx. Dysfunctions of ET are multifactorial, and the diagnostics is difficult due to lack of defined standards for assessing its function prior and post treatment. Aim: The aim of the study is the review of the publications concerning actual definitions and classification of ET dysfunctions, efforts of adopting unified criteria and methods of assessing its functions and ways of treatment. Material and methods: In the year 2015 classification was adopted which distinguish three subtypes of ET dysfunction: (1) dilatory ET dysfunction, (2) baro-challenge-induced, (3) patulous ET. Dilatory ET dysfunctions were further divided as follows: functional obstruction (most common), dynamic dysfunction and anatomical obstruction. The Eustachian Tube Dysfunction Questionnaire (ETDQ-7) enables the systematization of symptoms. Clinical assessment of the patient with ET dysfunction should include otoscopy or otomicroscopy, tympanometry, Rinnes and Webers tuning fork tests or pure tone audiometry, nasopharyngoscopy with visualization of ET orifice and opening. Other tests of assessment of ET functions like tubomanometry, sonotubomanometry and pressure chamber tests are useful research tools. Endoscopic evaluation of ET orifice should encompass the assessment of mucosa of the torus tubarius and ET as well as dynamic process of ET opening. In surgical treatment of functional obstructions of ET, the most common method is balloon dilatation tuboplasty. Several studies showed that this is safe and in high percentage of cases successful method of treatment, however the indications for this type of surgery are not yet universally accepted.