Endoscopic examination of the eustachian tube: a step-by-step approach

The aim of this study was to develop a step-by-step approach for endoscopic examinations of the eustachian tube on awake patients and to report anatomic and functional findings.

Prospective study.

University hospital.

Convenience sample of seven individuals without a history of ear disease.

Diagnostic transnasal-transpharyngeal videoendoscopy of the eustachian tube with 30- and 70-degree rigid Hopkins rod endoscopes, 2.5- and 0.8-mm, 0-degree flexible fiber endoscopes performed under local anesthesia in 12 eustachian tubes.

Utility of the various endoscopes for the diagnosis in the different parts of the eustachian tube; quality of vision and the patient's comfort during the procedure.

The 2.5-mm flexible endoscope was most useful for examination of the pharyngeal ostium and the cartilaginous lumen of the tube. The isthmus region could only be passed using an 0.8-mm fiberscope. In all cases, it was possible to insert the endoscope into the middle ear cavity. Eleven of the 12 tube examinations showed normal findings. The mobility of the tubal cartilage could be visualized with sufficient quality. In 50% of all examinations, application of local anesthesia via a tube catheter was necessary to make the procedure tolerable.

The presented approach allows an assessment of both anatomic and functional changes to the eustachian tube in awake patients. The assessment of middle ear structures is limited. To ensure a comfortable and safe procedure, the use of topical anesthesia in a supine position and, in certain cases, additional anesthesia via eustachian tube catheter is recommended.